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u  I  21  .A6  An2        Anthrax  as  an  occupa   k 


U.  S.  DEPARTMENT  OF  LABOR 
BUREAU  OF  LABOR  STATISTICS 


ROYAL  MEEKER,  Commissioner 


BULLETIN  OF  THE  UNITED  STATES  1  /WHOLE  ^fiC 

BUREAU   OF    LABOR    STATISTICS/    '■  '  '    \  NUMBER  £U  J 


INDUSTRIAL      ACCIDENTS     AND      HYGIENE      SERIES:     No.      10 


ANTHRAX  AS  AN  OC- 
CUPATIONAL DISEASE 


By  JOHN  B.ANDREWS,  Ph.D. 


JANUARY,  1917 


WASHINGTON 

GOVERNMENT  PRINTING  OFFICE 

1917 


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U.  S.  DEPARTMENT  OF  LABOR 
BUREAU   OF   LABOR   STATISTICS 

ROYAL  MEEKER,  Commissioner 

BULLETIN  OF  THE  UNITED  STATES  \  /WHOLE  ^CkC 

BUREAU    OF    LABOR    STATISTICS/    '    "   '    \  NUMBER  LA3  J 

INDUSTRIAL      ACCIDENTS      AND      HYGIENE      SERIES:      No.       10 


ANTHRAX  AS  AN  OC- 
CUPATIONAL DISEASE 


By  JOHN   B.  ANDREWS,  Ph.  D. 


JANUARY,  1917 


WASHINGTON 

GOVERNMENT  PRINTING  OFFICE 

1917 


ADDITIONAL  COPIES 

OF  THIS  PUBLICATION  MAY  BE  PROCURED  FEOM 

THE  SUPERINTENDENT  OF  DOCUMENTS 

GOVERNMENT  PRINTING  OFFICE 

"WASHINGTON,  D.  C. 

AT 

25  CENTS  PER   COPY 


./U2L. 


CONTENTS. 


Page. 

Introductory  summary 5-7 

Chapter  I  .—General  description  and  history  of  anthrax 9-13 

Early  studies  of  the  disease 9 

Discovery  of  the  bacillus 10 

Characteristics  of  bacillus  and  spore 11, 12 

Animals  subject  to  anthrax,  and  countries  where  the  disease  is  prevalent. .         12 
Conditions  of  soil  and  temperature  favorable  to  the  development  of  anthrax .        13 

Modes  of  infection 13 

Chapter  II. — Medical  aspects  of  human  anthrax 15-18 

Symptoms 15, 16 

Treatment 16-18 

Chapter  III. — Industries  affected 19-23 

Agriculture  and  other  industries  involving  direct  contact  with  animals 19 

Leather  industry 19,  20 

Animal  hair  and  bristle  industry 20,  21 

Wool  industry. . . . 21,  22 

Horn  and  bone  industry 22 

Transportation 22 

Nonoccupational  anthrax 23 

Chapter  IV. — Anthrax  in  the  United  States 25-93 

Early  experience 25-32 

Recent  experience 32-80 

Experience  of  a  leading  morocco-leather  center 32-35 

Cases  reported  under  New  York  occupational  disease  reporting  law 35-37 

Cases  reported  under  New  Jersey  occupational  disease  reporting  law .  .  37,  38 
Cases  reported  under  Pennsylvania  infectious  disease  reporting  law ...  38,  39 

Cases  on  record  in  a  Philadelphia  hospital 39-41 

Cases  on  record  in  a  Massachusetts  hospital 41-43 

Cases  reported  by  tanners  and  leather  manufacturers 43-46 

Fatal  cases  reported  in  registration  area  of  the  United  States,  1910  to 

1915 46-77 

Distribution  by  industry,  place  of  death,  etc 47-55 

Statistical  summary 55-59 

Individual  histories  of  fatal  cases 60-78 

Probable  ratio  of  deaths  to  total  number  of  cases 78-80 

Legislation .  80-93 

Reporting 80-82 

Prevention 82-88 

Agriculture 82,  83 

Trade  and  manufacture 84-88 

Compensation 89-93 

Chapter  V . — Anthrax  in  Europe 95-114 

Private  activity 95-98 

Anthrax  Investigation  Board  for  Bradford  and  District 95,  96 

German  employers'  mutual  trade  associations 96,  97 

3 


4  CONTENTS. 

Chapter  V. — Anthrax  in  Europe — Concluded. 
Private  activity — Concluded. 

Association  of  French  Manufacturers  for  the  Prevention  of  Industrial    Page. 

Accidents 97 

Milan  Labor  Clinic  and  other  private  activity  in  Italy 97, 98 

International  organizations  and  congresses 98 

Governmental  investigations ." 98,  99 

Systematic  reporting  and  resultant  data 99-106 

Great  Britain 99-102 

Germany 102-104 

France 104 

Holland 104, 105 

Italy , 105,106 

Russia 106 

Protective  legislation 106-111 

Wool,  hair,  and  bristles 107-110 

Hides  and  skins 110,  111 

Compensation  for  anthrax  as  an  industrial  injury 112-114 

Chapter  VI. — Present  status  of  the  problem  of  disinfection 115-120 

Chapter  VII. — Recommendations  for  control  and  prevention  of  anthrax 121-125 

Recommendations  of  the  subcommittee  of  International  Association  for 

Labor  Legislation,  1914 121-123 

Recommendations  by  Prof.  L.  Devoto  and  F.  Massarelli 123, 124 

Recommendations  by  C.  H.  W.  Page 124, 125 

Appendix  A.— Rules  and  regulations  in  the  United  States 126-135 

United  States:  Treasury  Department  and  Department  of  Agriculture  Joint 
Order  No.  1,  Regulations  governing  the  certification  and  disinfection  of 
hides,  fleshings,  hide  cuttings,  parings,  and  glue  stock,  sheepskins  and 
goatskins  and  parts  thereof,  hair,  wool,  and  other  animal  by-products, 
hay,  straw,  forage,  or  similar  material  offered  for  entry  into  the  United 

States,  1916 126-130 

Massachusetts:  Rules  and  regulations  suggested  for  the  prevention  of 

anthrax,  1916 131-134 

New  York:  State  industrial  commission,  division  of  industrial  hygiene, 

recommendations,  1916 134-135 

Appendix  B. — Text  of  European  regulations 136-150 

^ Great  Britain:  Regulations  for  handling  dry  and  dry-salted  hides  and  skins 

imported  from  China  or  from  the  West  Coast  of  India,  1901 136 

Great  Britain:  Sorting,  willowing,  washing,  combing,  and  carding  wool, 

goat  hair,  and  camel  hair,  and  processes  incidental  thereto,  1905 137-140 

Great  Britain:  Regulations  for  the  processes  involving  the  use  of  horsehair 

from  China,  Siberia,  or  Russia,  in  effect  April  1,  1908 141-143 

France:  Decree  relating  to  special  hygienic  measures  for  establishments 

where  the  workers  are  exposed  to  anthrax  infection,  1913 143-145 

Germany:  Order  concerning  the  equipment  and  operation  of  horsehair- 
spinning  establishments,  of  shops  where  other  animal  hair  and  bristles 

are  manipulated,  and  of  brush  factories,  1902 145-148 

Prussia:  Order  relating  to  the  propagation  of  anthrax  through  animal  skins, 

1902 148, 149 

Prussia:  Regulations  for  the  protection  of  workers  against  the  dangers  of 
anthrax,  1910 149, 150 


BULLETIN  OF  THE 
U.  S.  BUREAU  OF  LABOR  STATISTICS. 

WHOLE  NO.  205.  WASHINGTON.  JANUARY,  1917. 

ANTHRAX  AS  AN  OCCUPATIONAL  DISEASE. 

BY  JOHN   B.   ANDREWS,  PH.   D.1 

INTRODUCTORY  SUMMARY. 

A  sudden  and  startling  increase  in  the  number  of  illnesses  and 
deaths  from  anthrax  in  the  United  States  drew  public  attention  to 
this  occupational  disease  during  the  closing  months  of  1915  and 
the  early  part  of  1916.  Most  of  the  increase  took  place  in  seaports 
and  tannery  towns  in  the  three  States  of  New  York,  Massachusetts, 
and  Pennsylvania.  New  York,  for  instance,  reported  more  deaths 
from  the  malady  in  1915  than  had,  previously  occurred  in  any  State 
in  any  single  year  since  the  Census  Bureau  began  to  give  anthrax 
a  separate  place  in  the  mortality  statistics.  In  Massachusetts  more 
cases  were  reported  during  the  first  six  months  of  1916  than  in  any 
preceding  whole  year  since  the  infectious  disease  reporting  law  in 
that  State  went  into  effect. 

The  relative  importance  of  anthrax  is  shown  by  the  fact  that  for 
every  five  deaths  from  lead  poisoning  reported  in  the  United  States 
registration  area  there  is  one  death  from  anthrax,  and  that  the  total 
number  of  anthrax  cases  is  about  five  times  the  number  of  fatalities. 
One  Delaware  physician  was  able  to  furnish,  from  his  own  prac- 
tice, data  on  48  cases  treated  within  six  years.  During  the  same 
period  a  single  Philadelphia  hospital  treated  32  cases,  6  of  which 
were  fatal.  In  three  years  one  State  workmen's  compensation  com- 
mission passed  upon  30  claims  arising  from  this  occupational  disease. 

Anthrax  is  primarily  a  disease  of  animals  such  as  cattle  and  sheep, 
but  is  transmitted  to  man  in  a  number  of  industrial  pursuits.  In- 
cluded among  those  who  have  died  of  it  in  this  country  are  hide  and 
skin  handlers  and  other  tannery   employees,  longshoremen,  wool- 

1  Of   information    from    scores    of    physicians,    hospitals,    and    public    officials  in    this 

country   and    Europe   during   the   past    five   years,   and   of   painstaking   analysis  by   two 

faithful   assistants,   Anna  Kalet  and   Solon   de   Leon,   grateful   acknowledgment  is   here 
made. 


6  BULLETIN   OF    THE   BUREAU    OF    LABOE    STATISTICS. 

sorters,  hair  workers,  brush  makers,  paper  makers,  farmers,  ranch- 
men, liverymen,  and  veterinarians.  Among  nonfatal  cases  reported 
in  several  States  and  by  a  number  of  hospitals  the  same  groups  of 
occupations  are  strongly  represented.  Infection  has  even  taken  place 
in  a  carpenter,  a  steam  fitter,  and  a  stationary  engineer,  all  of  whom 
worked  in  tanneries,  and  in  a  customhouse  official  who  weighed  hides 
and  wool  on  the  docks.  In  some  nonoccupational  cases  the  disease 
has  been  spread  by  insects  and  by  pet  animals  which  had  been  feed- 
ing on  diseased  carcasses. 

The  bacillus  of  anthrax  is  one  of  the  largest  and  most  easily  recog- 
nized of  disease-producing  organisms,  and  its  discovery  about  the 
middle  of  the  last  century  marks  the  beginning  of  modern  bacteri- 
ology. The  bacillus,  however,  is  not  so  much  to  be  feared  as  a  cause 
of  disease  as  the  spore,  which  is  so  resistant  that  it  is  used  as  a  test 
object  for  standardizing  germicides.  The  spore  can  survive  for  as 
long  as  17  years  without  nutriment,  is  easily  carried  about,  and  when 
provided  with  a  favorable  environment  rapidly  germinates  and  sets 
up  a  focus  of  infection. 

In  man  contagion  commonly  occurs  through  an  abrasion  of  the 
skin,  resulting  in  the  so-called  "  malignant  pustule  "  or  in  "  malignant 
edema."  Woolsorter's  disease,  or  pulmonary  anthrax,  is  a  less  fre- 
quent but  almost  invariably  fatal  form  of  the  malady,  caused  by 
inhaling  dust  or  particles  of  hair  or  wool  from  diseased  animals. 
In  rare  cases  the  spores  find  entrance  to  the  digestive  system  and  pro- 
duce a  gastrointestinal  attack.  The  method  of  treatment  most  fre- 
quently used  hitherto  is  excision  of  the  pustule  where  possible,  some- 
times supplemented  by  intravenous  injections  of  antianthrax  serum. 
Now,  however,  some  successful  physicians  are  advocating  for  ex- 
ternal cases  nothing  more  drastic  than  rest  for  the  affected  part, 
stimulants,  and  local  treatment  with  iodine  and  wet  bichloride  of 
mercury  dressings.  Often  in  internal  cases,  physicians  admit,  the 
disease  fails  to  be  diagnosed  and  its  discovery  is  a  "  surprise  of  the 
autopsy." 

In  Europe  both  private  and  public  forces  have  combined  to  carry 
on  an  energetic  campaign  against  industrial  anthrax.  The  Anthrax 
Investigation  Board  for  Bradford  and  District,  in  England,  the 
German  and  the  French  employers'  mutual  trade  associations,  and 
the  famous  Labor  Clinic  at  Milan,  Italy,  have  all  made  valuable 
studies  of  the  disease  and  assisted  in  establishing  preventive  measures. 
The  governments  of  the  leading  countries  long  ago  drafted  and  se- 
cured the  careful  enforcement  of  sanitary  rules  for  the  dangerous 
industries,  including  wool  sorting,  washing,  combing,  and  carding, 
hair  sorting,  brush  making,  and  tanning.  Further  researches  in 
efficient  and  practicable  methods  of  disinfection  are  still  under  way. 


ANTHEAX   AS   AX    OCCUPATIONAL   DISEASE.  7 

In  at  least  seven  foreign  countries  anthrax  is  compensated  as  an 
industrial  accident. 

In  the  United  States,  on  the  other  hand,  the  problem  has  as  yet 
been  given  less  consideration,  although  legislation  for  the  report- 
ing of  anthrax,  both  as  an  infectious  and  as  an  occupational  disease, 
is  now  fairly  widespread  and  in  some  progressive  States  valuable 
data  are  regularly  being  collected. 

In  the  field  of  prevention,  especially,  the  United  States  lags 
behind.  Precautions  taken  by  employers  on  their  own  initiative 
are  crude  and  few  in  number.  Antianthrax  serum  is  scarce  and  not 
readily  available.  No  specific  factory  or  workshop  regulations  for 
safeguarding  working  men  and  women  from  the  disease  have  yet 
been  enacted  by  any  State.  The  most  effective  American  provisions 
on  the  subject  are  contained  in  joint  administrative  orders  of  the 
Federal  Departments  of  the  Treasury  and  Agriculture,  which,  be- 
ginning January  1,  1917,  prohibits  the  importation  of  hides,  hoofs, 
wool,  hair,  or  other  products  from  animals  affected  with  anthrax 
and  establishes  detailed  requirements  for  the  disinfection  of  these 
products  if  imported  from  districts  where  anthrax  is  prevalent  and 
for  the  disinfection  of  conveyances  and  of  certain  premises.  The 
period  during  1915  and  1916  when  much  laxer  requirements  were 
in  force  corresponds  roughly  with  the  period  of  highest  anthrax 
frequency  yet  recorded  in  the  United  States,  especially  among  long- 
shoremen and  tannery  employees,  and  the  connection  would  seem 
to  be  more  than  accidental. 

Two  States  authorize  workmen's  compensation  for  all  anthrax 
contracted  in  the  course  of  employment,  and  in  one  State  (Massa- 
chusetts) a  score  of  awards  under  this  enlightened  principle  have 
already  been  rendered.  In  a  few  other  States  compensation  pay- 
ments have  been  made  for  anthrax  contracted  as  the  result  of  a 
definite  injury  received  while  at  work.  With  the  gradual  spread  of 
workmen's  compensation  to  include  all  personal  injuries  in  the 
course  of  employment,  and  with  the  probable  development  of  health 
insurance  in  this  country,  an  added  incentive  will  be  furnished  for 
the  prevention  of  this  deadly  disease. 


CHAPTER  I. 
GENERAL  DESCRIPTION  AND  HISTORY  OF  ANTHRAX. 

EARLY  STUDIES  OF  THE  DISEASE. 

It  was  not  until  the  latter  half  of  the  eighteenth  century  that 
valuable  treatises  on  the  subject  of  anthrax  or  splenic  fever  (French, 
"charbon";  German,  "  Milzbrand  ")  began  to  appear.1  In  1769 
Fournier,  of  Dijon,  France,  published  his  historic  work  "  Charbon 
Malin,"  wherein  a  step  was  made  toward  recognizing  the  connection 
between  the  various  forms  of  anthrax.  At  about  the  same  time  the 
ravages  of  the  disease  became  so  serious  and  the  need  for  a  remedy 
so  urgent  that  the  Academy  of  Dijon  offered  a  prize  for  essays  on 
the  subject.  Some  of  the  works  submitted  were  remarkable  for  the 
thoroughness  and  precision  with  which  they  described  the  main  symp- 
toms of  human  anthrax.  These  first  scientific  researches  practically 
mark  the  beginning  of  the  literature.  Since  then,  at  more  or  less 
regular  intervals,  treatises  on  the  disease,  both  in  man  and  in  ani- 
mals, have  continued  to  appear. 

It  was  not,  however,  until  a  century  later  that  the  true  nature  of 
anthrax  was  revealed.  In  France  in  1849  an  investigation  was  under- 
taken by  a  group  of  medical  men,  in  the  course  of  which  it  was 
established  that  anthrax  in  man  and  anthrax  in  animals  are  identical. 
Then  began  a  search  for  the  causes  of  the  disease.  The  theories  ad- 
vanced are  characteristic  of  the  ante-Pasteur  period  when  the  mys- 
teries of  bacteriology  were  still  undisclosed  and  infectious  diseases 
were  explained  by  spontaneous  generation  and  by  other  subsequently 
discarded  hypotheses.  For  anthrax,  the  influence  of  soil,  the  sum- 
mer's heat,  storms,  insanitary  conditions  of  stalls  and  stables,  and 
errors  in  diet 2  were  some  of  the  causes  assigned. 

xThe  origin  of  anthrax  is  lost  in  antiquity.  Some  authors  trace  it  even  to  the  time  of 
Moses  and  identify  it  with  the  sixth  plague  of  Egypt.  Allusions  to  it  are  believed  to  be 
found  in  Homer.  Virgil  at  the  end  of  the  Third  Georgic  gives  a  very  vivid  description 
of  an  outbreak  among  domestic  animals,  the  symptoms  of  which  leave  little  doubt  as  to 
its  being  anthrax.  Hippocrates,  Galen,  and  Pliny  the  Elder  all  describe  carbuncles, 
which  are  diagnosed  as  anthrax  by  some  modern  authorities.  Periodic  devastating 
epidemics  of  the  disease  are  mentioned  by  numerous  writers,  medieval  and  modern. 

2  Thus  Delafond,  a  French  veterinary  surgeon,  held  at  one  time  that  anthrax  in  sheep 
was  caused  by  "  an  excess  of  blood  circulating  in  the  vessels,"  due  to  "  too  copious  and 
too  substantial  feeding."  (Delafond  :  Traits  sur  la  maladie  du  sang  des  betes  a  laine, 
1843.  Quoted  by  J.  Cavaill<§ :  Le  Charbon  Professionnel,  1911,  p.  8.)  At  a  still  earlier 
date  Chabert,  director  and  inspector  general  of  the  Royal  Veterinarian  College  of  Prance, 
declared  that  "  anthrax  tumors  in  general  may,  and  should,  be  regarded  as  the  effects  of 
an  effort  of  nature  to  rid  itself  of  the  humor  with  which  it  is  surcharged  and  the  expul- 
sion of  which  it  is  important  to  assist  by  all  means  that  may  achieve  this  result.'* 
(Traite  du  charbon  ou  anthrax  dans  les  animaux,  Paris,  1782,  p.  33.) 

9 


10  BULLETIN"   OF   THE   BUREAU    OF   LABOR  STATISTICS. 

DISCOVERY  OF  THE  BACILLUS. 

The  anthrax  bacillus  was  the  first  bacterium  of  disease  ever  dis- 
covered, and  its  isolation  marks  the  birth  of  the  modern  science  of 
bacteriology.  In  1850  a  French  village  physician  named  Rayer,  in 
collaboration  with  Davaine.  found  in  the  blood  of  a  sheep  which  had 
died  of  anthrax  what  he  called  "  little  threadlike,  motionless  bodies, 
about  twice  the  length  of  a  blood  globule."1  Five  years  later,  in 
1855,  a  similar  result  was  obtained  by  a  German  scientist,  Pollender. 
None  of  these  men  at  the  time  of  their  discovery,  however,  was  able 
to  explain  the  nature  of  these  bodies  or  their  relation  to  the  disease, 
nor  was  anyone  aware  of  the  greatness  of  their  contribution  to  human 
knowledge. 

Davaine,  after  a  long  series  of  experiments,  came  to  the  conclusion 
that  these  bodies,  constantly  present  in  the  blood  and  organs  of 
animals  dying  of  anthrax,  were  absolutely  distinct  from  the  bacteria 
of  putrefaction  which  were  being  studied  by  his  contemporaries,  and 
that  in  them  would  undoubtedly  be  found  the  cause  of  the  disease.2 
This  forecast  was  brilliantly  fulfilled  in  1876  by  Robert  Koch,  who 
later  discovered  the  bacillus  of  tuberculosis.  Koch  conclusively 
proved 3  the  causal  relation  of  the  bacterium  to  the  disease,  and  fur- 
thermore demonstrated  that  the  anthrax  organism  passed  through 
the  two  stages  of  bacillus  and  spore  which  had  previously  been  made 
out  by  Pasteur  in  connection  with  a  silkworm  blight. 

At  this  point  Pasteur  took  up  the  inquiry.  The  fact  that  certain 
investigators,  even  after  Koch's  demonstration,  maintained  that  the 
disease  often  occurred  without  the  presence  of  bacteria  led  him  to 
subject  the  work  of  his  predecessors  to  rigorous  verification.  He 
resorted  to  the  method  of  successive  cultures.  In  a  nutritive  liquid 
he  placed  a  minute  quantity  of  fresh  anthrax  blood ;  a  large  number 
of  bacteria  appeared ;  a  drop  of  this  liquid  produced  a  new  culture 
which  also  showed  germs,  and  so  on  to  20  cultures.  Since  the  last 
culture  certainly  contained  not  a  particle  of  the  original  anthrax 
blood,  and  since  it  had  the  power  to  produce  anthrax  by  inoculation, 
Pasteur  decided  that  it  was  not  blood,  but  bacteria,  that  constituted 
the  cause  of  anthrax.  He  also  verified  Koch's  observations  of  the 
reproduction  of  the  bacteria  through  fission  and  by  spores.  The 
experiments  of  these  men.  by  presenting  for  the  first  time  a  complete 
account  of  the  etiology  of  anthrax,  answered  the  most  important 
question  in  connection  with  this  disease  and  made  possible  its  further 
scientific  study. 

1  Comptes  rendus  de  la  Society  de  Biologie,  1850,  p.  141.  Quoted  by  J.  Cavaille:  Le 
Charbon  Professionnel,  1911,  p.  11. 

2  Comptes  rendus  de  1'  Academie  des  Sciences,  1863,  vol.  57,  pp.  320,  351.  Quoted  tiy  J. 
Cavaille\  op.  cit.,  p.  14. 

3  Robert  Koch  :  Die  Aetiologie  der  Milzbrandkrankheit  begriindet  auf  die  Entwicklungs- 
gescbichte  des  Bacillus  Anthracis,   1876.     Leipsig,   1910.     47   pp. 


ANTHRAX  AS   AN    OCCUPATIONAL   DISEASE.  11 

CHARACTERISTICS  OF  BACILLUS  AND  SPORE. 

The  bacillus  of  anthrax  (Bacillus  anthracis)  is  a  cylindrical  or 
rodlike  body  of  3^^  to  -^jj  inch  in  length  and  about  25^0o  inch  in 
diameter.  Viewed  with  a  microscope  it  is  motionless,  straight,  and 
transparent.  In  the  blood  and  other  fluids  of  a  living  animal,  which 
form  the  most  favorable  media,  the  bacillus  multiplies  very  rapidly 
by  fission.  The  rodlike  body  becomes  longer  and  divides  into  two 
or  more  individuals  similar  to  the  parent.  The  multiplication  of  the 
bacillus  can  take  place  only  in  the  presence  of  substances  entering 
into  the  composition  of  the  bacillus  itself,  namely,  water,  nitrates, 
carbohydrates,  and  minerals ;  a  temperature  of  53.6°  to  113°  F.  and 
a  supply  of  oxygen  are  also  necessary. 

Another  mode  of  reproduction  is  by  means  of  spores.  Spores  can 
be  formed  in  a  medium  similar  to  that  favorable  to  the  segmentation 
of  the  bacillus,  except  that  free  oxygen  is  necessary ;  for  this  reason 
spores  never  form  in  the  blood  of  a  living  animal.  Given  the  pres- 
ence of  free  oxygen,  sporulation  takes  place  when  the  medium  be- 
comes "  impaired,  either  because  it  was  deprived  by  the  bacillus  of 
some  of  its  essential  substances  or  because  it  became  adulterated  by 
the  accumulation  of  products  secreted  by  the  microbe." *  Under 
such  conditions  the  bacillus  instead  of  dividing  into  segments 
grows  into  a  long  thread  inside  of  which  oval -shaped  spores  appear, 
regularly  spaced,  "  like  peas  in  a  pod."  The  surrounding  protoplasm 
is  dissolved  or  reabsorbed,  and  the  spores  are  liberated.  Thus  the 
spore  seems  to  be  formed  at  the  expense  of  the  bacillus  itself ;  it  is,  so 
to  speak,  the  bacillus  in  a  condensed  form,  and  when  placed  in  a  fa- 
vorable medium  it  germinates  and  again  becomes  a  bacillus.  The 
spore  has  been  the  subject  of  numerous  researches  and  its  nature  is 
well  known.  It  has  been  discovered  that,  unlike  the  bacillus,  the  spore 
is  marvelously  resistant,  a  circumstance  which  makes  the  struggle 
with  the  disease  particularly  difficult.  The  spore  contains  in  itself  the 
elements  necessary  for  life  and  can  subsist  for  years  in  an  environ- 
ment entirely  devoid  of  nutritive  materials,  while  the  bacillus,  left 
to  itself,  very  soon  dies.  Dr.  Rebentisch,2  of  Offenbach,  Prussia, 
states  that  after  having  lain  dormant  for  17  years  the  spore  is  still 
capable  of  germination. 

In  their  susceptibility  to  heat,  the  microorganisms  also  differ  con- 
siderably. Blood  of  anthrax-infected  animals,  containing  bacilli 
only,  loses  its  virulence  if  exposed  for  15  minutes  to  a  temperature 
of  131°  F.  The  spore,  however,  is  much  more  resistant.  Two  hours 
of  boiling  are  required  to  kill  all  spores  contained  in  a  liquid  culture; 
raised  in  such  a  medium  to  221°  F.  a  few  spores  may  resist  for  about 

1  J.  Cavaille :  Le  Charbon  Professionnel,  Berger-Levrault,  editeurs,  Paris,  1911,  p.  43. 

2  Gewerbliche  Milzbrandvergiftungen,  in  Zentralblatt  fiir  Gewerbehygiene,  May,  1913, 
p.  201. 


12  BULLETIN   OF    THE   BUREAU    OP   LABOR   STATISTICS. 

15  minutes.  In  a  dry  medium  the  spores  stand  a  temperature  of  248° 
to  266°  F,  Drying,  if  carried  out  rapidly,  destroys  the  bacillus  but 
hardly  affects  the  spore. 

Equally  resistant  is  the  spore  to  antiseptics;  numerous  experi- 
ments have  shown  that  while  the  bacillus  is  easily  destroyed,  only 
very  high  doses  and  prolonged  exposure  have  any  effect  on  the 
spore.  Nammack  states  that  "even  catgut,  prepared  from  the  sub- 
mucosa  of  the  intestines  of  infected  sheep,  has  been  known  to  defy 
all  the  elaborate  preparations  of  modern  surgical  technique,  and 
still  conyey  anthrax  infection  to  a  wound." x  In  fact,  so  hardy  are 
the  spores  that  they  have  long  been  used  as  test  objects  for  determin- 
ing the  efficacy  of  germicides  and  of  other  destructive  agencies.2 
This  circumstance  explains  the  difficulties  in  the  way  of  sterilization 
of  materials,  a  question  which  will  be  taken  up  later  in  detail. 

ANIMALS  SUBJECT  TO  ANTHRAX,  AND  COUNTRIES  WHERE  THE 
DISEASE  IS  PREVALENT. 

Anthrax  is  primarily  a  disease  of  animals,  from  whom  it  is  con- 
tracted directly  or  indirectly  by  human  beings.  It  is  particularly 
frequent  among  cattle  and  sheep,  but  may  also  be  transmitted  to 
goats,  horses,  hogs,  dogs,  cats,  and  certain  kinds  of  game.  Mice, 
rabbits,  and  guinea  pigs,  in  the  laboratory  experiments,  are  very 
susceptible,  while  fowl  are  practically  immune.  This  considerable 
variety  of  animals  subject  to  anthrax  aggravates  the  dangers  of  the 
disease. 

Another  serious  factor  is  its  world-wide  distribution.  Hardly  a 
country  in  the  world  is  known  to  be  entirely  exempt,  while  a  number 
of  localities  are  reputed  to  be  particularly  affected.  Of  the  European 
countries,  Russia  and  Italy  are  reported  to  be  most  severely  affected 
by  both  animal  and  human  anthrax.  Well-enforced  laws  prescrib- 
ing preventive  vaccination  of  animals  and  complete  destruction  of 
carcasses  have  succeeded  in  making  it  comparatively  rare  in  Eng- 
land, Germany,  France,  and  a  few  other  European  countries.  In 
the  United  States,  anthrax  is  frequent  among  animals  in  the  lower 
Mississippi  Valley,  in  the  Gulf  States,  in  the  East  (chiefly  on  the 
banks  of  the  Delaware  River),  and  in  some  of  the  Western  States. 
On  the  South  American  Continent  it  is  prevalent  in  the  less  civ- 
ilized districts  of  Argentina,  and  in  Patagonia  and  Uruguay.  The 
worst  ravages  of  the  disease,  however,  are  reported  from  Asiatic 
countries,  mainly  Siberia,  Persia,  Asia  Minor,  Tibet.  China,  and 
India,  where  ph.ysiographical  conditions,  deplorable  ignorance,  and 
utter  indifference  conspire  to  make  the  materials  exported  from 
those  countries  the  most  dangerous  known  to  anthrax  experts. 

1  Charles  E.  Nammack  :  A  Case  of  Anthrax ;  Excision ;  Recovery,  in  New  York  Medical 
Journal,  1897,  vol.  66,  p.  80. 

2  E.  O.  Jordan  :  General  Bacteriology,  1912,  p.  217. 


ANTHRAX   AS   A1ST    OCCUPATIONAL  DISEASE.  13 

CONDITIONS   OF   SOIL  AND  TEMPERATURE   FAVORABLE   TO  THE 
DEVELOPMENT  OF  ANTHRAX. 

The  frequency  of  animal  anthrax  in  certain  countries  is  explained 
not  only  by  the  absence  of  precautionary  measures,  the  most  urgent 
of  which  are  preventive  vaccination,  complete  destruction  of  car- 
casses, and  rational  disposal  of  waste  products  of  manufacture,  but 
also  by  conditions  of  soil  and  temperature.  Anthrax  is  mainly 
observed  on  black,  loose,  humus  soils,  also  on  swampy  land  under 
which  impervious  strata  are  found.  Outbreaks  are  frequent  in 
places  where  spring  inundations,  which  frequently  wash  over  un- 
buried  carcasses,  are  followed  by  a  dry  hot  summer.  The  moisture 
contained  in  these  kinds  of  soil,  and  the  organic  matter  always  abun- 
dant, furnish,  if  combined  with  favorable  temperature,  an  excellent 
medium  for  the  development  of  bacilli  and  spores  when,  after  the 
inundation,  the  land  dries,  and  the  germs  are  either  left  in  the  ground 
or  disseminated  by  the  wind. 

MODES  OF  INFECTION. 

Most  cases  of  animal  anthrax  are  attributed  to  infection  from 
fodder,  either  through  grazing  on  fields  where  carcasses  of  victims 
of  the  disease  have  been  left,  or  through  eating  hay  cut  from  such 
fields.  Water  from  streams  receiving  discharges  from  establish- 
ments using  infected  material,  artificial  manure,  and  imported  food- 
stuffs are  also  frequent  causes.1  Transmission  through  blood-sucking 
insects  has  been  experimentally  demonstrated,2  but  only  rarely  is  the 
disease  due  to  the  entrance  of  germs  into  the  air  passages,  and  seldom 
does  it  occur  in  animals  through  infection  of  wounds. 

Human  beings  contract  the  disease  mainly  through  the  handling 
of  infected  animal  materials,  either  when  these  materials  are  ob- 
tained by  them  directly  from  animals  or  else  when  they  are  being 
transported  or  manipulated  in  industrial  processes.  Workers 
handling  infected  goods  sometimes  transmit  the  disease  to  members 
of  their  families,  either  by  means  of  clothing3  or  through  contact, 
while  they  themselves  may  escape.  Bites  of  insects  and  even  of  pet 
animals  which  presumably  had  been  feeding  on  diseased  material  have 
been  known  to  convey  the  infection,  and  in  some  cases  the  eating  of  dis- 
eased meat  has  been  suspected.  A  certain  number  of  cases  are  also 
due  to  the  spores  which  have  sometimes  been  found  in  shaving  brushes. 


1  In  November,  1915,  for  instance,  an  anthrax  outbreak  occurred  among  the  cattle  of 
farmers  owning  grass  lands  along  the  Johns  River,  N.  II.,  who  fed  their  live  stock  hay 
cut  from  those  lands.  According  to  the  State  department  of  agriculture,  the  trouble 
seemed  to  arise  from  a  tannery  which  emptied  its  waste  into  the  river.  A  State  veteri- 
narian contracted  the  disease  while  making  a  post-mortem  examination,  but  recovered. 
See  also   pp.   28   and  30. 

2  M.  B.  Mitzmain  :  Experimental  Transmission  of  Anthrax,  reprint  No.  162  from  the 
U.  S.  Public  Health  Reports. 

3  The  Journal  of  the  American  Medical  Association  for  Apr.  2t>,  1913,  for  instance, 
contained  an  account  of  a  woman  in  London  who  contracted  anthrax  presumably  from 
the  clothes  of  her  husband,  who  was  a  laborer  handling  hides. 


APPEARANCE  OF  ANTHRAX   BACILLI  AND  SPORES. 


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fig.  1.— Anthrax  bacilli 

(MAGNIFIED    ABOUT    800    diameters). 


fig.  2.— Anthrax  spores 

(magnified   about   1200   diameters). 


COMMON  APPEARANCE  OF   ANTHRAX   ON   THE  SKIN: 


fig.  3— 1st  or  2nd  Day. 


fig.  4— 3rd  or  4th  Day. 


fig.  5.— Later  stage. 


oensCo.Bahimare 


CHAPTER  II. 
MEDICAL  ASPECTS  OF  HUMAN  ANTHRAX. 

SYMPTOMS. 

Human  anthrax  is  caused  by  the  entrance  into  the  body  of  anthrax 
bacilli  or  spores,  and  by  their  rapid  development  and  multiplication 
in  the  favorable  media  there  encountered.  In  a  majority  of  cases  in- 
oculation takes  place  through  a  scratch  or  cut  in  the  skin ;  in  such  case 
external  anthrax  results.  This  can  be  of  two  kinds,  (1)  malignant 
pustule,  (2)  malignant  edema  or  erysipelatous  anthrax.  More  rarely 
the  germs  are  inhaled  and  infect  the  respiratory  organs,  or  enter 
with  food  into  the  digestive  tract;  this  is  the  origin  of  internal 
anthrax,  with  its  two  forms,  (1)  pulmonary  and  (2)  gastrointestinal. 

Many  exaggerated  ideas  of  the  deadliness  of  the  disease  have  been 
current,1  but  it  is  now  known  that  the  vast  majority  of  cases  end  in 
recovery.  Rebentisch2  describes  the  main  symptoms  of  malignant 
pustule  as  follows :  The  disease  begins  with  a  red  pimple  of  the  size  of 
a  pin's  head,  formed  at  the  point  of  inoculation.  As  there  is  hardly 
any  pain,  very  little  attention  is  paid  by  the  patient  to  the  disease 
in  this  stage.  The  pimple  rapidly  increases  in  size.  It  becomes  sur- 
rounded by  a  peculiar,  resilient  swelling,  often  of  considerable  extent, 
the  so-called  anthrax  edema.  In  the  center  of  the  pustule  there  is 
a  black  spot  around  which  the  skin  rises  in  blisters,  this  black  spot 
having  given  to  the  disease  its  French  name  of  charbon.  The  ap- 
pearance of  the  affected  place  is  very  characteristic  and  makes  a  last- 
ing impression  on  anyone  who  sees  it.  On  the  third  or  fourth  day 
the  lymphatic  glands  in  the  vicinity  of  the  pustule  are  usually  swollen 
and  painful.  In  cases  where  the  pustule  is  situated  in  the  front  part 
of  the  neck,  the  inflammation  may  attack  the  larynx  and  thus  endan- 
ger the  patient's  respiration.  Pustules  may  appear  on  several  parts 
of  the  patient's  body,  but  such  cases  are  rare.3 

Except  for  the  local  symptoms,  slight  cases  are  uneventful.  Se- 
rious attacks  are  marked  by  fever  and  by  accelerated  heart  activity. 
In  critical  cases  the  patient  complains  of  weakness  and  pain,  and 

1  An  up-State  New  York  paper  in  1913  even  went  so  far  as  to  print  the  remarkable 
statement :  "  So  malignant  is  the  disease  that  there  is  no  known  remedy  for  it,  infection 
being  invariably  fatal." 

.  2  Gewerbliehe  Milzbranderkrankungen,  in  Zentralblatt  fiir  Gewerbehygiene,  May,  1913, 
pp.  202,  203. 

3  See  colored  plate ;  also  Plate  2,  facing  p.  18.  Figs.  1  and  2  are  from  Associazione 
degli  Industriali  d'ltalia  per  prevenire  gli  infortuni  del  lavoro :  Istruzioni  agli  operai  per 
prevenire  il  Carbonchio.  Milano,  1909.  Figs.  3,  4,  and  5  are  from  Great  Britain, 
Factory  Inspector's  office,  Form  410,  March,  1908. 

42806°— Bull.  205—17- 2  15 


1G  BULLETIN    OF    THE   BUREAU    OF    LABOR   STATISTICS. 

delirium  is  not  infrequent.  If  the  bacilli  penetrate  into  the  blood 
stream  and  are  not  quickly  overcome,  the  condition  of  the  patient 
becomes  worse  and  the  disease  takes  a  fatal  turn.  The  complete 
cycle  of  the  disease  occupies  on  the  average  9  or  10  days.  Sometimes 
death  occurs  much  sooner. 

In  the  other  form  of  external  anthrax,  malignant  edema,  the  pus- 
tule is  absent.  The  edema  or  swelling  usually  covers  an  extensive 
surface  and  is  most  frequently  situated  on  the  eyelid,  neck, -or  fore- 
arm. "  The  local  symptoms,"  states  Bell,  "  are  the  extensive  edema, 
in  slight  cases,  without  redness,  vesication,  or  eschar ;  in  severe  cases, 
with  redness,  vesication,  and  a  gangrenous  appearance  of  the  skin. 
There  may  be  no  pain,  no  distress,  and  no  fever.  Even  in  fatal  cases 
these  are  not  very  marked." 1  This  form  of  the  disease  occurs  much 
less  frequently  than  the  pustule. 

The  internal  varieties  of  anthrax  are  comparatively  rare.  The 
symptoms  are  not  characteristic  and  can  be  easily  mistaken  for  those 
of  a  number  of  other  infectious  diseases;  this  makes  diagnosis  very 
difficult  and  causes  frequent  error.  According  to  Xebolioubov.  inter- 
nal anthrax  is  often  a  "  surprise  of  the  autopsy  " ;  it  is  also  very  pos- 
sible that  many  cases  escape  diagnosis. 

Gastrointestinal  anthrax,  says  Straus,2  "  begins  quite  suddenly  with 
general  weakness,  pains,  and  shivering;  this  is  followed  by  digestive 
troubles,  vomiting,  colic,  distention  of  the  stomach,  diarrhea ;  the 
whole  body  is  affected;  there  is  difficulty  in  breathing,  weak  pulse, 
and  cyanosis ;  death,  most  frequently  in  a  state  of  collapse,  but  excep- 
tionally with  tetanus-like  convulsions,  occurs  in  from  two  to  five  days 
after  the  appearance  of  the  first  symptoms." 

Pulmonary  anthrax,  more  frequent  than  the  intestinal  form  of  the 
malady,  is  also  known  as  woolsorter's  disease.  According  to  the 
authority  just  cited,  one  of  its  first  symptoms  is  "  extreme  weakness, 
combined  with  headache  and  profuse  perspiration ;  soon  there  appear 
constrictive  pains  in  the  chest,  difficult  breathing,  and  cyanosis;  aus- 
cultation reveals  congestion  and  edema  in  the  lungs ;  sometimes  there 
is  delirium;  the  patient  dies  in  a  collapse;  the  disease  usually  lasts 
from  4  to  8  days,  but  sometimes  death  comes  more  suddenly."  3 

TREATMENT. 

In  the  treatment  of  anthrax  the  resistance  of  the  human  body  to 
bacterial  infection  is  a  factor  of  considerable  importance.  A  number 
of  physicians  have  tested  the  method  of  "  expectant  treatment,"  based 
only  on  the  resistance  of  the  body,  and  found  it  successful  in  both 

1  Anthrax — Its  Relation  to  the  Wool  Industry.  John  Henry  Bell,  in  Dangerous  Trades, 
by  Thomas  Oliver.  London,  1902,  p.  637. 

2 1.  Straus:  Le  Charhon  des  Animaux  et  de  1'Homme,  1887,  p.  203. 
3  Idem,  p.   207. 


ANTHRAX   AS   AN   OCCUPATIONAL   DISEASE.  17 

local  and  general  affections.  The  prevailing  tendency  among  med- 
ical men,  however,  has  been  toward  more  energetic  therapeutic 
methods. 

The  kinds  of  treatment  now  most  frequently  used  are  extirpation, 
medicinal  treatment,  and  serotherapy,  either  singly  or  in  combina- 
tion. Extirpation  of  the  lesion  by  excision,  when  it  is  in  an  operable 
location,  has  been  practiced  since  the  eighteenth  century.  A  vari- 
ant of  this  method  is  extirpation  by  cautery — either  actual  cautery 
with  a  hot  iron,1  or  cautery  by  means  of  phenol  or  some  other  corro- 
sive acid.  By  some,  however,  including  a  number  of  very  success- 
ful practitioners,  the  method  of  extirpation,  especially  by  excision, 
is  at  present  held  to  be  unreliable  and  dangerous.  The  excision,  it 
is  said,  does  hot  always  remove  all  the  infected  tissue,  while  the  knife 
in  opening  the  vesicles  may  facilitate  the  entrance  of  the  bacteria 
into  the  circulation  and  thus  make  conditions  worse. 

For  the  medicinal  treatment  of  anthrax,  great  faith  was  at  one 
time  placed  in  such  supposed  remedies  as  oak  bark,  lemon  juice, 
tobacco  leaves,  and  roast  onions,  but  these  have  now  been  discarded 
in  favor  of  more  scientific  applications.2  For  instance,  one  experi- 
enced American  physician  who  in  the  last  eight  years  has  treated 
more  than  42  cases  affecting  the  cutaneous  and  cellular  tissues  thus 
describes  his  method: 

The  part  is  thoroughly  but  gently  washed  with  1 :  2,000  chloride  of  mercury 
solution,3  dried  well,  then  swabbed  with  10  per  cent  tincture  of  iodine  and 
some  alkali  applied.  This  is  repeated  daily  for  several  days  until  the  slough  has 
come  away.  It  takes  about  two  or  three  weeks  for  an  ulcer  to  heal,  which  it  does, 
with  very  little  scar  as  compared  with  the  tissues  involved.  No  systemic  treat- 
ment is  necessary  other  than  cleaning  out  the  bowels,  though  some  require 
strychnine  and  alcoholic  stimulants.  If  the  trachea  becomes  much  involved, 
nothing  will  prevent  death  by  suffocation.  It  has  been  my  experience  that 
if  the  vesicles  are  kept  unruptured  it  is  better  for  the  patient.  The  fatal 
cases  I  have  seen  were  those  in  which  the  vesicles  had  been  ruptured.4 

In  some  cases  internal  administration  of  certain  antiseptics,  chiefly 
iodine,  is  resorted  to.  These  antiseptics  can  not  be  given  in  doses  suf- 
ficient to  destroy  the  bacteria,  but  they  are  effective  in  impeding  their 
multiplication.    Tonics  and  stimulants  such  as  quinine,  alcohol,  wine, 

A  Successful  treatment  of  an  anthrax  case  by  actual  cautery  was  reported  from 
Riverhead,  N.  Y.,  in  the  summer  of  1916.     The  patient  was  a  prosperous  farmer. 

2  A.  N.  Bell,  one  of  the  first  American  writers  on  anthrax,  records  a  case  in  which 
"a  physician  was  called,  who,  thinking  the  disease  to  be  erysipelas,  ordered  the  applica- 
tion of  24  leeches,  to  be  followed  by  a  poultice  of  cow  manure."  (Malignant  Pustule  in 
the  United  States,  1862,  p.  16.) 

8  The  danger  attending  the  use  of  mercuric  chloride  in  this  manner  is  illustrated  -by  an 
instance  described  by  Balderston.  A  physician  called  in  to  a  case  found  the  patient 
suffering  from  anthrax,  and  around  the  pustules  a  number  of  punctures  made  by  a  hypo- 
dermic needle.  On  being  asked  what  he  had  injected,  the  physician  who  first  had  the 
case  in  charge  replied  bichloride  of  mercury.  "  He  was  not  able  to  say  exactly  how  much 
had  been  given,  but  the  man  died  of  bichloride  poisoning."  (Journal  American  Leather 
Chemists'  Association,  July,  1916,  p.  341.) 

*  John  Palmer,  jr.,  in  Journal  American  Medical  Association,  Nov.  6,  1915,  p.  1670. 


18  BULLETIN    OF    THE   BUBEAU    OF    LABOR  STATISTICS. 

or  coffee,  as  well  as  the  inhalation  of  oxygen,  are  also  reported  to  be 
beneficial. 

Serotherapy,  the  third  modern  method,  is  as  yet  hardly  beyond 
the  experimental  stage,  but  it  holds  out  important  promise  for  the 
future.  It  consists  of  the  injection,  usually  intravenously,  of  fluids 
from  an  immunized  animal,  containing  germicides  or  having  a  neu- 
tralizing effect  on  the  germ's  secretions.  Several  kinds  of  serum 
have  been  tested  and  found  more  or  less  effective.  Perhaps  the 
greatest  success  is  credited  to  the  serum  produced  in  1895  by 
Prof.  Sclavo,  of  Siena,  Italy.  At  first  he  experimented  on  ani- 
mals, but  in  1897  began  to  use  his  serum  on  human  beings.  After 
six  years  he  collected  the  records  of  all  cases  in  which  his  serum 
had  been  applied,  and  found  that,  out  of  161  cases,  only  10  had 
resulted  fatally.  This  mortality  rate  of  6.1  per  cent  is  very  low 
as  compared  with  that  of  21.1  per  cent  which  is  the  general  rate  re- 
ported by  Italian  statistics.  The  value  of  this  serum  is  recognized  in 
Italy  to  such  an  extent  that  in  some  cities  workers  in  tanneries  and 
hair  factories  demand  vaccination  as  soon  as  they  notice  a  suspicious 
mark  on  their  skin.1  Eecently  the  manufacture  of  antianthrax  serum 
has  been  undertaken  by  a  well-known  American  firm,  but  even  the 
American  article  is  highly  expensive,  80  to  100  cubic  centimeters 
being  required  for  the  initial  dose,  at  a  cost  of  from  $28  to  $35. 
It  is  still  too  early  to  form  a  definite  judgment  of  the  value  of 
serotherapy,  but  it  is  commended  by  a  number  of  anthrax  authorities, 
and  its  use  is  continually  extending.  It  is,  for  instance,  combined 
with  excision  when  possible  in  the  routine  treatment  for  all  cases 
of  anthrax  admitted  into  certain  prominent  American  hospitals  and 
into  the  Bradford  Infirmary  in  England.  In  other  anthrax  centers 
serum  is  given  without  practicing  excision  and  with  very  successful 
results. 

Xo  matter  what  mode  of  treatment  is  adopted,  prompt  diagnosis 
and  rest  for  the  affected  part  are  stressed  by  leading  authorities. 

1  J.  Cavaiile :  Le  Charbon  Professionnel,  p.  112. 


CHAPTER  HI. 

INDUSTRIES  AFFECTED. 

AGRICULTURE  AND  OTHER  INDUSTRIES  INVOLVING  DIRECT 
CONTACT  WITH  ANIMALS. 

Anthrax  in  man  is,  in  the  great  majority  of  cases,  of  occupational 
origin.  In  a  number  of  occupations  anthrax  is  transmitted  to  the 
workers  directly  by  animals.  Farm  laborers,  shepherds,  butchers, 
flayers,  and  veterinarians,  for  instance,  contract  the  infection  by 
coming  in  immediate  contact  with  the  diseased  animals  or  with  their 
carcasses. 

More  numerous  are  the  groups  of  persons  who  handle,  for  the  pur- 
pose of  manufacture,  materials  derived  from  infected  animals.  Such 
materials  are  used  in  several  very  important  industries,  including  the 
wool  industry,  the  manufacture  of  leather  and  leather  goods,  work 
on  bristles  and  hair,  and  making  artificial  manure.  Protection  of 
the  workers  is  particularly  difficult  in  the  leather  industry,  since 
reliable  and  practicable  means  of  disinfection,  such  as  exist  for  hair 
and  bristles,  have  not  yet  been  conclusively  worked  out  for  hides 
and  skins. 

LEATHER  INDUSTRY. 

No  country  in  which  the  leather  industry  has  developed  to  any  de- 
gree of  importance  can  depend  entirely  on  its  own  supply  of  hides 
and  skins.  These  products  come  in  enormous  quantities  from  less 
highly  developed  countries,  where  manufacturing  is  hardly  known 
but  where  vast  lands  furnish  favorable  conditions  for  successful  stock 
raising.  In  these  regions  sanitation  is  usually  unknown  or  neglected, 
and  clean  materials  are  packed  in  the  same  bale  with  those  which 
have  been  infected.  Materials  imported  from  China,  India,  and 
other  Asiatic  countries,  and  from  some  localities  in  Africa,  and  South 
America,  are  considered  particularly  dangerous. 

The  hides  and  skins  are  usually  imported  in  a  raw  state.  Before 
being  used  in  manufacture  they  must  be  subjected  to  the  process 
of  tanning.  Upon  their  arrival  at  the  tannery  the  skins  are  sorted 
and  then  soaked.  This  soaking  brings  the  "dry"  hides  to  a  moist 
flexible  state,  which  is  necessary  for  a  more  complete  absorption  of 
the  tannin  from  the  subsequent  tan  liquors.  All  kinds  of  skins — 
"dry,"  "wet  salted,"  and  "green"  (fresh) — are  cleansed,  in  the 
"  soak,"  from  earth,  blood,  and  dirt  adhering  to  them  and  from  any 

19 


20  BULLETIN"   OF   THE  BUREAU   OF   LABOR  STATISTICS. 

preservatives  with  which  they  may  previously  have  been  treated. 
The  "  soak  "  may  consist  of  fresh  water  or  of  water  to  which  anti- 
septics have  been  added,  the  contents  of  the  fluid,  the  time  of  ex- 
posure, and  the  details  of  the  process  varying  in  different  establish- 
ments. This  treatment,  although  it  does  not  succeed  in  destroying 
the  spores,  nevertheless  diminishes  considerably  the  risk  of  anthrax 
infection,  because  it  washes  away  the  blood,  dirt,  and  other  sub- 
stances containing  spores.  The  next  step  is  to  remove  the  hair.  For 
this  purpose  the  materials  are  placed  in  pits  containing  a  saturated 
solution  of  slaked  lime,  where  they  remain  for  several  days,  accord- 
ing to  the  class  to  which  they  belong.  Even  this  prolonged  lime  bath, 
which  is  a  powerful  disinfectant  for  many  purposes,  is  unable  to 
kill  the  anthrax  spores.  "  As  a  result  of  the  action  of  the  lime  the 
hair  is  easily  removed  with  a  special  knife.  Then,  any  adhering 
particles  of  flesh  are  scraped  off ;  the  skins  are  "  delimed,"  that  is, 
the  remains  of  the  lime  are  washed  off;  and  this  is  followed  by  the 
steps  immediately  preceding  tanning  and  by  tanning  itself.1 

The  incidence  of  anthrax  varies  in  the  different  processes.  Reben- 
tisch,2  as  a  result  of  his  own  researches  and  those  of  the  German 
Leather  Industry  Accident  Association,  came  to  the  conclusion  that 
.only  a  small  number  of  cases  occurred  among  workers  in  the  depart- 
ments where  dry  skins  were  manipulated,  whereas  the  majority  of 
victims  were  engaged  in  the  processes  of  soaking  and  washing. 
Cavaille,  from  his  study  of  the  tawing  works  in  the  city  of  St.  Denis, 
France,  reached  a  similar  conclusion.3  American  and  British  ex- 
perience, however,  seems  to  contradict  this,  the  majority  of  tannery 
cases  in  both  these  countries  occurring  in  the  early  dry  processes 
such  as  unloading,  storing,  and  sorting. 

The  various  manufacturing  processes,  by  additional  cleaning  of  the 
skins,  still  further  reduce  the  danger  of  anthrax,  but  are  not  capable 
of  removing  it  completely.  There  is  always  the  possibility  of  fin- 
ished leather  conveying  the  disease.  In  support  of  this  theory 
Constant  Ponder  gives  the  following  evidence  collected  by  him  from 
various  authors:4  (1)  Shoemakers  who  have  handled  only  leather 
have  contracted  anthrax;  (2)  horses  have  contracted  anthrax  on  the 
flank  where  a  new  pair  of  reins  touched  them;  (3)  it  has  been  shown 
that  the  spore  sometimes  survives,  unharmed,  the  processes  of  tanning. 

ANIMAL  HAIR  AND  BRISTLE  INDUSTRY. 

Another  group  of  industries  where  the  danger  of  anthrax  is  pres- 
ent is  that  involving  the  manipulation  of  animal  hair  and  bristles. 

1  See  Plates  4  and  5. 

2  Gewerbliche  Milzbranderkrankungen,  in  Zentralblatt  fur  Gewerbehygiene,  June,  1913, 
p.  249. 

3  J.  CavaillS  :   Le  Cbarbon  Professional,  p.  132. 

*  Constant  Ponder :  A  Report  to  the  Worshipful  Company  of  Leather  Sellers  on  the 
Incidence  of  Anthrax  among  Those  Engaged  in  the  Hide,  Skin,  and  Leather  Industries, 
with  an  Inquiry  into  Certain  Measures  Aiming  at  Its  Prevention.     London,  1911,  p.  17. 


ANTHRAX  AS   AN    OCCUPATIONAL  DISEASE.  21 

The  hair  is  obtained  from  horses,  asses,  mules,  and  oxen ;  the  bristles 
from  hogs  and  wild  boars.  The  hair  is  used  for  making  haircloth, 
cords,  gloves,  and  a  number  of  other  articles,  and  for  stuffing  pillows, 
mattresses,  chairs,  and  saddles.  The  manufacturing  countries  do  not 
depend  upon  their  own  supply  of  hair  but  import  large  quantities 
from  China,  Russia,  South  America,  and  other  places,  China  supply- 
ing more  bristles  than  any  other  oriental  country.  Of  all  the  vari- 
eties of  hair,  Eussian  horsehair  is  considered  the  most  dangerous. 

The  hair  reaches  the  factory  in  large  compressed  bales  weighing 
several  hundred  pounds.  Upon  the  bales  being  opened  the  hair  is 
sorted  according  to  color,  length,  and  strength.1  Then  it  is  either 
shaken  on  a  screen  or  combed.  This  process  removes  the  dust  from 
the  hair  and  separates  the  long  hair  from  the  short.  The  former 
method  is  used  in  weaving,  the  latter  in  brush  making.  To  make  per- 
manent the  curl  in  hair  used  for  stuffing  pillows,  mattresses,  chairs, 
and  saddles,  the  hair  is  steamed  for  15  to  20  minutes  under  a  pressure 
of  1  to  2  atmospheres;  other  methods,  such  as  exposure  to  dry  heat 
under  ordinary  pressure,  are  also  used  for  the  purpose.  After  dyeing, 
if  this  takes  place,  .the  hair  is  rinsed,  dried,  and  packed.  Dyeing  is  a 
very  welcome  process  as  far  as  prevention  of  anthrax  is  concerned, 
because  the  hair  is  left  for  several  hours  in  a  solution  heated  by  the 
passage  of  steam.  The  heat  is  never  sufficient  to  destroy  the  germs, 
but  the  dirt  is  removed  and  probably  the  virulence  of  the  spores  is 
diminished ;  however,  the  hair  is  not  often  dyed. 

The  early  processes  of  opening,  sorting,  and  combing  involve  a 
greater  degree  of  risk  than  the  subsequent  manipulation.  This  risk 
is  increased  by  the  filth  and  dust,  both  of  which  are  notorious  carriers 
of  anthrax  germs. 

Bristles  upon  their  arrival  at  the  factory  are  also  sorted  and  sepa- 
rated from  the  dirt  and  from  all  bulky  foreign  matter;  to  remove 
the  finer  particles  of  filth  the  bristles  are  arranged  in  layers,  sprayed 
with  water,  and  left  for  a  time.  This  produces  decomposition  of 
the  still  adhering  foreign  substances,  which  are  then  easily  carried 
away  with  steel  combs.  After  that  the  bristles  are  rinsed  in  cold 
water,  tied  in  packages,  and  dried.  Frequently  the  better  sorts  of 
bristles  arrive  sorted  and  cleansed.  As  in  the  case  of  hair,  the  first 
operations — unpacking,  sorting,  and  combing — are  more  risky  than 
the  others,  and  the  prevalence  of  anthrax  among  the  workers  en- 
gaged in  them  has  attracted  considerable  attention.2 

WOOL  INDUSTRY. 

The  danger  of  anthrax  is  also  present  to  a  very  marked  degree 
in  the  wool  industry.    Wool  is  obtained  chiefly  from  goats,  sheep, 

1  See  Plate  3,  facing  p.  19. 

2  Two  days  after  he  injured  his  finger  while  at  work  in  the  factory  of  the  New 
Haven  Brush  Co.,  its  president,  Elmer  W.  Griswold,  died  Dec.  24,  1916,  of  anthrax 
which  the  physicians  believed  was  communicated  to  the  wound  from  au  Infected  bristle 
of  a  hairbrush. 


22  BULLETIN   OP   THE   BUREAU    OF    LABOR   STATISTICS. 

and  camels  and  is  imported  from  some  of  the  oriental  countries,  such 
as  Asiatic  Turkey,  Arabia,  Tibet,  and  Persia,  also  from  Russia  and 
from  some  localities  in  South  America  and  Australia.  Like  hair  and 
bristles,  it  frequentty  reaches  the  factory  in  a  filthy  state.  Upon 
opening,  the  wool  is  sorted  according  to  color  and  quality,  after 
which  it  is  freed  from  dust  in  the  willowing  machines,  and  blended 
so  as  to  obtain  a  uniform  color  in  bulk.  Then  each  sort  is  put  several 
times  in  succession  through  an  alkaline  bath  at  130°  F.  This  re- 
moves any  remaining  dust  and  dirt  and  dissoh^es  the  blood  clots, 
which  adhere  to  the  wool  with  extreme  tenacity  and  which,  if  from 
an  animal  which  has  suffered  from  anthrax,  contain  abundant  spores. 
After  rinsing  and  drying  the  wool  is  either  combed  or  carded,  ac- 
cording to  the  use  for  which  it  is  designed.  The  processes  in  the 
wool  industry,  as  in  the  industries  previously  described,  vary  in 
different  establishments.  Particularly  dangerous  are  the  early  opera- 
tions, since  the  dirt  and  dust  are  laden  with  germs;  indeed,  pulmo- 
nary anthrax  owes  its  special  title,  "  woolsorter's  disease,"  to  its 
appearance  almost  exclusively  among  workers  in  dusty  wool  proc- 
esses. The  liberation  of  the  spores  by  the  alkaline  bath  accounts  for 
cases  in  the  later  processes  of  carding  and  combing. 

HORN  AND  BONE  INDUSTRY. 

Among  other  imported  animal  materials  utilized  in  industry,  horns 
and  bones  are  occasionally  a  source  of  infection.  They  are  used  in 
the  manufacture  of  combs,  buttons,  knife  handles,  corset  bones,  and 
smoking  pipes.  During  the  breaking,  cutting,  and  chipping,  small 
sharp  fragments  are  projected  which  wound  the  worker  and  in  this 
way  facilitate  inoculation. 

TRANSPORTATION. 

The  simple  handling  of  infected  goods  during  their  transportation 
has  also  been  shown  to  cause  anthrax.  Longshoremen,  porters  in 
warehouses,  and  other  transportation  workers  frequently  contract 
anthrax  while  loading  or  unloading  infected  materials.  Sometimes 
anthrax  is  transmitted  to  these  workers  not  through  immediate  con- 
tact with  animal  products,  but  indirectly.  Cases  are  known  of 
laborers  having  become  infected  from  cargoes  of  corn,  wheat,  and 
barley.  Apparently  the  grain  had  come  in  contact  with  infected 
animal  products  or  was  stored  in  places  where  such  merchandise  was 
previously  kept. 

Cases  of  anthrax  also  appear  among  workers  in  glue  factories, 
rag-sorting  works,  felt  factories,  and  establishments  where  fertilizers 
and  artificial  animal  food  are  being  prepared.  The  danger  of  in- 
fection in  these  occupations  is  comparatively  slight. 


ANTHRAX    AS    AN    OCCUPATIONAL   DISEASE.  23 

NONOCCUPATIONAL  ANTHRAX. 

Anthrax  statistics  also  include  many  cases  of  persons  between 
whose  occupation  and  the  disease  no  connection  can  be  traced,  such 
as  children,  housewives,  persons  without  any  occupation,  schoolboys, 
teachers,  and  professional  men.  In  1915  and  1916  several  widely 
scattered  British  cases  of  the  disease,  including  one  death,  were 
definitely  traced  to  shaving  brushes,  manufactured  by  one  firm  from 
bristles  of  Chinese  origin;  a  number  of  the  suspected  brushes  were 
examined  and  found  to  contain  anthrax  spores  which  had  survived 
the  processes  of  manufacture.1  This  possibility  of  unexpected  at- 
tack and  the  fatal  consequences  which  may  ensue,  even  despite 
energetic  treatment,  add  greatly  to  the  urgency  of  adequate  measures 
for  eradicating  the  menace. 

1  Report  of  the  County  Medical  Officer  and  School  Medical  Officer  for  the  year  1915. 
London  County  Council,  August,  1916,  quoted  in  Monthly  Review  of  the  U.  S.  Bureau 
of  Labor  Statistics,  November,  1916,  pp.  108-110. 


CHAPTER  IV. 
ANTHRAX  IN  THE  UNITED  STATES. 

The  record  of  anthrax  in  the  United  States  forms  an  absorbing 
chapter  in  the  annals  of  the  country's  tardy  but  gradual  movement 
toward  the  recognition  and  prevention  of  occupational  (disease. 
Practically  all  the  industries  in  which  anthrax  occurs  are  to  be  found 
in  this  country,  and  cases  have  been  known  to  medical  men  for  the 
better  part  of  a  century.  It  is  only  in  recent  years,  however,  that 
industrial  and  community  responsibility  for  the  disease  has  been 
brought  to  the  fore,  and  social  activity  for  its  control  is  still  in  the 
early  stages. 

EARLY  EXPERIENCE. 

Early  American  experience  with  anthrax  is  recorded  only  in 
occasional  papers  by  medical  men  who  came  in  contact  with  inter- 
esting cases,  and  the  story  thus  preserved  is  necessarily  very  incom- 
plete. Perhaps  the  first  human  cases  so  recorded  in  the  United 
States  occurred  in  Philadelphia  in  1834.1  An  epizootic  of  "  mur- 
rain "  broke  out  among  the  cattle  near  that  city  and  finally  spread 
to  the  city  itself,  prevailing  especially  among  cattle  that  fed  on  the 
common.  Several  persons  who  had  been  engaged  in  skinning  animals 
that  had  died  of  murrain  were  affected  with  the  malignant  pustule. 
Of  the  three  patients  who  were  treated  by  the  historian  of  the  out- 
break, one  stated  that  "  while  he  was  skinning  a  cow  dead  of  murrain 
a  mosquito  bit  him  on  the  back  of  the  hand.  With  the  other  hand, 
which  was  covered  with  the  blood  of  the  cow,  he  brushed  away  the 
mosquito  and  rubbed  the  itching  bite."  In  all  three  cases  the  infec- 
tion was  on  the  hand,  and  all  ended  in  recovery.  A  fourth  case 
occurred  in  the  following  year  (1835).  A  milkman  skinned  a  cow 
which  had  died  of  murrain  and  carried  the  hide  on  his  bare  arm. 
Several  days  later  he  noticed  a  pustule  on  his  arm,  from  which  he 
eventually  recovered.  In  all  these  cases  the  symptoms  of  the  malig- 
nant pustule  in  man  were  well  characterized. 

By  1835,  also,  large  numbers  of  human  cases  had  occurred  in  Lou- 
isiana.    Eight  of  these  were  described  by  one  physician,2  who  traced 

1  C.  W.  Pennock  :  On  the  Malignant  Pustule ;  With  Cases,  in  American  Journal  of  Medi- 
cal Science,  Vol.  XIX,  November,  1836,  pp.  13-25. 

2  William  M.  Carpenter  :  A  Treatise  on  Malignant  Pustule.  Thesis  submitted  to  the 
faculty  of  the  Medical  College  of  Louisiana,  1836  ;  also  Southern  Medical  Journal,  Febru- 
ary, 1839,  pp.  257-274. 

25 


26  BULLETIN"   OP    THE   BUREAU    OF   LABOR   STATISTICS. 

the  history  of  malignant  pustule  in  the  region  back  to  the  time  of 
its  settlement  by  the  French  and  believed  that  the  disease  was  first 
noticed  in  America  among  deer  feeding  on  the  salt  marshes  near  the 
mouth  of  the  Mississippi  River.  Later  it  attacked  the  planters' 
cattle,  returning  annually,  and  by  the  time  he  wrote  it  was  prevalent 
in  nearly  every  part  of  the  State,  but  "  seems  not  to  have  been  even 
noticed  in  the  medical  annals  of  America."  During  1851  Louisiana 
was  visited  by  an  anthrax  epidemic  which  was  compared1  to  that 
described  in  the  first  book  of  Homer's  Iliad : 

On  mules  and  dogs  the  infection  first  began, 
And  last  the  vengeful  arrows  fixed  on  man. 

In  several  cases  the  disease  was  communicated  to  men  by  fly  bites, 
and  once  by  dressing  the  lesion  of  an  infected  mule.  In  Mississippi 
outbreaks  of  anthrax  among  animals  occurred  at  intervals  after  1836, 
the  losses  of  cattle  in  1865  and  1867  being  particularly  heavy. 

In  New  England  anthrax  seems  not  to  have  attracted  attention 
until  a  later  date  than  in  the  Southern  States.  In  1852  detailed 
accounts  of  six  cases  were  published  by  a  Salem  (Mass.)  physician,2 
who  stated  that  for  some  time  previously  he  had  seen  a  case  every 
few  years.  He  enumerated  several  occupations  in  which  the  disease 
occurred,  but,  in  common  with  other  physicians  of  the  period,  he 
indicated  little  knowledge  of  its  nature.  Seven  years  later  four 
cases  in  New  York,  three  of  which  terminated  fatally,  were  described.3 

An  important  addition  to  the  literature  on  anthrax  was  made  in 
1862,  in  the  report  on  "  Malignant  pustule  in  the  United  States," 
by  A.  N.  Bell,  a  physician  at  the  Brooklyn  (N.  Y.)  City  Hospital.  In 
this  work  Bell  summarizes  several  previous  American  publications 
on  the  subject  and  describes  cases  which  occurred  in  his  own  prac- 
tice. He  states  that  when  a  fatal  case  of  malignant  pustule  came 
up  for  discussion  before  the  Kings  County  Medical  Society  in  July, 
1859,  members  declared  the  disease  had  existed  in  Brooklyn  for  only 
about  four  years.  In  December  of  the  same  year  three  other  cases 
were  reported  to  the  society.  Bell  himself  saw  several  other  cases, 
and  heard  of  10  more  in  Brooklyn  and  of  several  in  New  York. 
He  also  gave  the  names  of  several  physicians  in  the  States  of  Maine, 
Massachusetts,  Rhode  Island,  and  New  York  who  had  treated  cases 
of  anthrax.  Bell's  experience  with  the  disease  convinced  him  of 
the  value  of  early  diagnosis,  the  importance  of  which  has  been 
proved  by  later  authorities.  "  Of  all  the  diseases  that  man  is  heir  to," 
he  states,  "there  is  none  in  which  an  early  diagnosis  is  more  im- 

1  James  H.  Baldridge  :  Malignant  Pustule,  in  New  Orleans  Medical  Journal,  September, 

1851,  pp.  200-204. 

2  A.  L.  Peirson :  Malignant  Tubercle,  in  Boston  Medical  and  Surgical  Journal,  Aug.  25, 

1852,  pp.  75-78. 

3  Buck,  in  New  York  Journal  of  Medicine,  1859. 


ANTHRAX   AS   AN    OCCUPATIONAL  DISEASE.  27 

portant  than  in  malignant  pustule.  It  is  indeed  of  such  moment 
that  the  lapse  of  a  few  hours  or  a  day  may  entail  the  most  deplorable 
consequences." 

Struck  by  the  repeated  occurrence  of  anthrax  in  the  vicinity  of 
Walpole,  Mass.,  a  Massachusetts  physician1  made  careful  inquiry 
and  found  that  in  1853  there  first  appeared  in  the  town  a  "most 
singular  disease,  which  was  recognized  by  the  attending  physician 
as  charbon,  or  malignant  vesicle,  a  malady  known  from  remote  an- 
tiquity as  prevailing  among  animals,  but  observed  among  mankind 
onty  within  a  comparatively  recent  period."  The  malady  had  been 
reported  from  that  locality  at  irregular  intervals  until  during  a 
period  of  17  years  26  cases  had  come  under  observation.  Twenty- 
four  of  these  cases  occurred  among  hair  workers,  one  victim  was  a 
carpenter  employed  in  a  hair  factory,  and  the  remaining  case  was 
that  of  the  wife  of  one  of  the  victims. 

.The  difficulties  in  the  way  of  diagnosing  anthrax  and  the  conse- 
quent underestimate  of  the  real  number  of  cases  were  recognized  at 
a 'comparatively  early  period.  "The  transmission  of  this  disease 
to  man,"  said  one  practitioner  in  1881,  "  is  far  more  frequent  than 
is  generally  supposed.  *  *  *  Under  the  names  of  black  erysipe- 
las, carbuncle,  diphtheria,  etc.,  many  cases  occur  that  are  easily 
traceable  to  infection  from  animals.  *  *  *  In  the  last  decade 
I  have  been  personally  cognizant  of  13  cases,  and  four  of  these  have 
occurred  within  the  past  two  years  in  a  town  of  10,000  inhabitants 
and  independently  of  factories  working  up  hair  or  hides,  which 
prove  the  most  frequent  sources  of  infection."2  The  author  con- 
sidered the  problem  of  sufficient  moment  to  demand  sanitary  legis- 
lation and  "  the  most  rigid  measures  for  the  suppression  of  anthrax 
outbreaks." 

The'  year  1892  is  considered  an  important  date  in  the  history 
of  anthrax  in  Delaware,  a  State  where  outbreaks  of  the  disease 
among  both  human  beings  and  animals  have  been  particularly  fre- 
quent. In  that  year,  according  to  Dr.  Charles  F.  Dawson  of  the 
Delaware  College  Agricultural  Experiment  Station,  anthrax  was 
"  officially  recognized  as  existing  in  Delaware."  This  date  seems 
late  as  compared  with  1834,  the  year  of  the  epidemic,  previously 
discussed,  near  Philadelphia,  and  1836,  the  date  of  the  earliest  re- 
ported outbreak  in  Mississippi.  However,  Dr.  Dawson  admits  that 
"  while  anthrax  has  been  known  to  exist  in  the  State  only  since 
1892,  it  is  highly  probable  that  the  first  cases  occurred  much  earlier 

1  Arthur  H.  Nichols:  On  the  Occurrence  of  Charbon,  or  Malignant  Vesicle,  in  Massachu- 
setts.    Massachusetts  Board  of  Health,  Annual  Report,  1872. 

2 James  Law:  Glanders  and  Anthrax,  in  Cyclopedia  of  Practical  Medicine  (supp.),  New 
York,  1881,  p.  202. 


28  BULLETIN"   OF    THE   BUREAU    OF    LABOR   STATISTICS. 

and  that  the  disease  is  as  old  as  the  morocco  industry." x  In  the 
outbreak  of  1892,  when  the  officials  were  admittedly  "  inexperienced 
in  the  management  of  this  disease,"  several  farmers  contracted  pus- 
tules. Since  that  year  outbreaks  of  anthrax  have  been  common 
in  Delaware.  "  Estimates  made  by  veterinarians  practicing  in  the 
State  show  from  175  to  200  farms  in  Delaware  that  are  perma- 
nently infected  with  anthrax.  *  *  *  The  infected  territory  com- 
prises about  one-third  of  the  total  area  of  the  State." 

Information  on  the  prevalence  of  anthrax  in  the  southern  and 
southwestern  parts  of  the  country  is  comparatively  limited.  In  1894 
an  epidemic  of  anthrax  was  reported  near  Como,  La.,  where  live  stock 
perished  in  large  numbers  and  many  people  contracted  the  disease, 
in  some  instances  with  fatal  results.  In  the  same  year  a  California 
medical  man2  stated  that  in  Ventura  County,  Cal.,  alone,  over  100 
cases  of  malignant  pustule  had  occurred  between  the  time  of  its 
first  recognition  and  the  date  of  his  article,  and  he  suggested  that 
some  cases  had  escaped  diagnosis. 

A  remarkable  case  is  recorded  by  Dr.  W.  P.  Mcintosh,  of  the 
United  States  Marine  Hospital  Service,  as  having  occurred  at  Boston. 
Eighteen  months  before  falling  ill  the  patient  worked  on  a  tramp 
steamer  which  carried  hides  from  a  South  American  port;  since 
that  time  he  had  been  employed  on  ordinary  seagoing  vessels. 
"  The  most  probable  exposure  was  at  the  time  when  the  man  was 
employed  on  the  vessel  transporting  hides  from  South  America. 
This,  however,  would  presuppose  that  he  had  carried  the  infective 
agent  about  with  him  as  part  of  his  personal  baggage  for  a  period 
of  18  months.  This  is  not  inconsistent  with  the  life  history  of  the 
anthrax  bacillus."3 

The  difficulties  encountered  by  early  physicians  in  the  diagnosis  of 
anthrax  are  well  described  by  Nammack.4  One  patient,  a  young 
fruit  handler  in  New  York  City,  felt  a  slight  pricking  or  burning 
sensation  in  the  right  eyebrow  and  upper  eyelid;  on  the  following 
day  the  lid  became  swollen.  A  surgeon  was  consulted  and  ordered  a 
lotion.  Next  morning  the  patient  went  to  an  eye  clinic,  where  he 
was  told  that  there  was  nothing  wrong  with  his  eye,  but  that  he  had 
cellulitis  of  the  lid;  he  was  referred  to  the  surgical  class  and  again 
given  a  lotion.  A  day  later  he  called  at  Nammack's  office.  The  lid 
then  presented  the  appearance  of  phlegmonous  cellulitis,  and  the 
doctor  prescribed  hot  boric  acid  lotions  and  ordered  him  to  return 
next  day  for  incision.     The  next  morning  a  messenger  called  to  say 

1  Bui.  No.  90,  Delaware  College  Agricultural  Experiment  Station,  1910.  Anthrax,  p.  17. 
The  manufacture  of  morocco  leather  from  imported  goatskins  was  established  on  a  small 
scale  in  Wilmington,  Del.,  as  early  as  1840. 

2  C.  L.  Bard,  in  Southern  California  Practitioner,  1894,  p.  121. 
8W.  P.  Mcintosh,  in  Medicine,  1897,  Vol.  Ill,  pp.  459^161. 

*  Charles  E.  Nammack :  A  Case  of  Anthrax ;  Excision  ;  Recovery,  in  New  York  Medical 
Journal,   1897,  Vol.   LXVI,   pp.   78-80. 


ANTHRAX   AS  AN    OCCUPATIONAL  DISEASE.  29 

that  the  patient  wasi  delirious  and  that  during  the  night  a  black 
pimple  had  developed  on  the  eyelid.  He  was  immediately  conveyed 
to  a  hospital  where  the  area  surrounding  the  "  charbon  "  was  excised, 
cauterized,  swabbed  out  with  pure  carbolic  acid,  and  then  inoculated 
with  cultures  of  the  bacillus  pyocyanicus.  Portions  of  the  excised 
tissue  were  sent  to  three  laboratories  and  anthrax  bacilli  were  re- 
ported. "  Three  observers  had  treated  the  case  as  one  of  ordinary 
phlegmonous  cellulitis."  The  probable  mode  of  infection  in  this 
case  was  very  unusual.  In  most  of  the  cases  which  Nammack  had 
previously  seen  the  men  had  been  handling  hides.  This  patient  was 
repacking  fruit  sent  to  a  commission  house.  Some  of  the  fruit  came 
from  Spain  in  crates  which  were  bound  with  strips  of  rawhide. 
As  he  cut  these  strips  one  would  occasionally  fly  up  and  hit  him  in 
the  face.  It  is  probable,  says  the  writer,  that  in  this  way  the  skin 
was  bruised  and  a  way  was  opened  for  the  entrance  of  the  microbe. 

During  the  closing  five  years  of  the  last  century,  accounts  of  anthrax 
became  very  frequent.  In  1896  the  fatal  case  occurred  of  a  Philadel- 
phia brush  maker,  who  had  been  working  on  hogs'  bristles  and 
horsehair  imported  from  Siberia  and  from  the  southern  part  of 
European  Russia.1  The  existence  of  the  disease  was  proved  bacte- 
riologically. 

The  next  year  five  cases  (four  fatal)  occurred  among  the  opera- 
tives of  a  Falls  Creek,  Pa.,  tannery.  Hides  imported  from  Asia  and 
infected  with  anthrax  were  found  to  be  the  source  of  contagion.2  The 
death  of  a  porter  in  a  Boston  leather  warehouse  was  described  in 
1898. 3  This  man  had  been  carrying  hides  on  his  shoulders.  One 
morning  while  shaving  he  noticed  a  small  "  pimple  "  on  his  neck. 
He  continued  his  work  on  that  and  on  the  following  day,  but  was 
taken  ill  the  day  after  and  went  to  the  hospital,  where  the  pustule 
was  excised ;  he  died  a  day  later.  Smears  from  the  vesicles  surround- 
ing the  pustule  showed  abundant  bacilli. 

Another  fatal  case  of  a  hide  handler  was  reported  the  same  year 
from  New  Orleans.4  The  patient  had  been  employed  in  one  of  the 
largest  hide  stores  in  the  city.  When  he  was  brought  to  the  hospital 
the  two  physicians  who  saw  him  concurred  in  diagnosing  the  disease 
as  anthrax.  Antistreptococcic  serum  was  injected,  but  the  patient 
died  on  the  tenth  day  of  his  illness.  In  his  account  of  the  case  Dr. 
Dabney  comments  on  the  "  scant  precautions  which  the  dealers  in 
hides  and  wool  in  this  county  take  for  the  protection  of  their  em- 
ployees against  this  disease."    Dabney,  like  several  other  writers,  is 

1 M.  B.  Miller :  A  Case  of  Anthrax,  in  Philadelphia  Medical  Journal,  1898,  Vol.  I, 
pp.  340-342. 

2  Medical  News,  January,  1897. 

8  Abner  Post,  in  Medical  and  Surgical  Reports  of  the  Boston  City  Hospital,  1898, 
pp.  226-232. 

*T.  S.  Dabney:  A  Case  of  Anthrax  (Charbon),  in  New  Orleans  Medical  and  Surgical 
Journal,    1898-99,    Vol.    LI,    pp.    377-383. 


30  BULLETIN   OF    THE   BUREAU    OF    LABOR   STATISTICS. 

convinced  that  many  anthrax  cases  remain  unrecognized.  "  I  can 
not  believe,"  he  says,  "  that  malignant  pustule  is  as  rare  as  our  hos- 
pital and  board  of  health  reports  would  lead  us  to  infer.  A  rather 
careful  look  through  the  incomplete  reports  of  the  Charity  Hospital 
from  1875  to  1897  fails  to  find  a  single  case  treated  in  that  institu- 
tion. *  *  .  *  We  are  forced  to  the  conclusion  that  many  cases  of 
anthrax  must  have  died  in  private  practice  as  well  as  in  our  public 
institutions,  under  the  diagnosis  of  erysipelas,  cellulitis,  carbuncle 
(ordinary),  blood  poisoning,  etc." 

Anthrax,  however,  is  by  no  means  confined  to  the  East  and  South. 
In  Wisconsin,  which  is  an  important  tanning  center  as  well  as  an 
agricultural  and  stock-raising  State,  an  epizootic  of  anthrax  oc- 
curred during  July  and  August  of  1899  among  the  cattle  in  a  certain 
district.  Not  less  than  five  persons  contracted  the  disease  through 
skinning  animals ;  in  all  these  cases  the  pustules  were  on  the  exposed 
parts  of  the  body.  Investigation  by  the  health  authorities  led  to 
the  conclusion  that  the  cases  among  animals  were  produced  by  drink- 
ing water  from  a  river  into  which  the  tannery  waste  was  discharged 
and  by  grazing  on  meadows  adjoining  this  river.1  In  the  same  sum- 
mer an  outbreak  of  anthrax  occurred  among  tannery  workers  in 
another  part  of  the  State. 

In  a  Philadelphia  case 2  in  1900  the  patient  was  a  "  card  stopper  " 
in  a  large  woolen  mill.  The  illness  began  when  he  sustained  a 
punctured  wound  on  his  forearm  while  at  work.  Eight  days  later 
he  was  admitted  to  the  hospital ;  the  arm  was  dressed  with  a  solu- 
tion of  bichloride  of  mercury,  1  to  10,000,  and  kept  wet  constantly. 
Next  day  1  dram  of  10  per  cent  carbolic  acid  was  injected;  on  the 
day  after,  1  dram  of  pure  carbolic  acid  was  used.  A  similar  injection 
was  made  daily  during  each  of  the  five  following  days.  A  week 
after  admission  the  patient  was  up. 

Lewald 3  describes  a  rapidly  fatal  case  of  anthrax  in  a  New  York 
stevedore  in  1902.  The  man  had  been  unloading  hides,  and  was 
admitted  to  the  erysipelas  pavilion  of  Bellevue  Hospital  on  March  1. 
Three  days  previously  he  had  noticed  a  small  pimple  on  his  neck; 
24  hours  after  that  he  was  ill  and  unable  to  work.  Upon  his  ad- 
mission to  the  hospital  he  continued  to  grow  worse  and  died  on  the 
following  day.  "  A  smear  was  made  from  the  wound  a  few  hours 
before  death,  and  the  examination  made  at  the  laboratory  confirmed 

1  In  November,  1916,  an  anthrax  outbreak  occurred  among  the  cattle  of  farmers  own- 
ing grass  lands  along  the  Johns  River,  N.  H.,  who  fed  their  live  stock  hay  cut  from 
these  lands.  According  to  the  State  department  of  agriculture,  the  trouble  seemed  to 
arise  from  a  tannery  which  emptied  its  waste  into  the  river.  A  State  veterinarian 
contracted  the  disease  while  making  a  post-mortem  examination,  but  recovered.  See 
also  pp.  13  and  88. 

2B.  W.  Fisher:  A  Case  of  Anthrax  Successfully  Treated  by  Local  Injection  of  Pure 
Carbolic  Acid,  in  Therapeutic  Gazette,  Detroit,   1900,  3s.,  Vol.  XVI,  pp.  508-510. 

3  L.  F.  Lewald :  A  Case  of  Anthrax,  in  Proceedings  of  the  New  York  Pathological 
Society,   February  and   March,   1902,   pp.    24-26. 


ANTHRAX  AS   AN    OCCUPATIONAL   DISEASE.  31 


the  diagnosis  of  anthrax."  In  the  discussion  on  the  case  the  opinion 
was  expressed  that  anthrax  is  more  frequent  in  New  York  City 
than  was  commonly  supposed.  "  Within  the  last  three  or  four 
years,  four  or  five  cases  have  come  into  the  dispensary  of  the  Hud- 
son Street  Hospital.  Singularly  good  results  have  been  obtained 
from  early  radical  excision." 

In  1905  Drs.  G.  J.  Schwartz  and  B.  F.  Eayer,1  both  of  Philadel- 
phia, described  to  the  Academy  of  Surgery  of  that  city  a  case  of 
anthrax  in  a  farmer,  who  contracted  the  illness  through  skinning  a 
cow.  In  the  pustule  which  formed  on  the  wrist  anthrax  bacilli  were 
found.  The  pustule  was  excised  and  the  patient  recovered  after  an 
illness  of  35  days.  In  their  report  of  the  case  the  authors  make  the 
following  comment  on  the  lack  of  serum  in  this  country :  "  From  data 
presented  by  Legge  *  *  *  and  Sclavo,  it  would  appear  that  the 
time  had  come  when  we  in  this  county  should  have  a  supply  of  anti- 
anthrax  serum  kept  by  health  boards  or  research  laboratories,  where  it 
might  be  gotten  in  a  few  hours  by  those  called  upon  to  treat  anthrax." 
When  the  patient  came  to  the  hospital  requests  for  serum  were  sent 
to  two  private  laboratories,  to  the  Marine  Hospital  Laboratory,  and 
to  the  Bureau  of  Health  of  New  York,  but  no  serum  could  be  found." 

Early  cases  of  human  anthrax  were  frequent  also  in  several  other 
States,  including  Texas.  In  that  important  stock-raising  State  out- 
breaks among  domestic  animals  occurred  repeatedly,  with  conse- 
quent infection  of  human  beings.  A  young  woman,  for  instance,  was 
bitten  in  the  face  by  an  insect  while  anthrax  was  raging  among  the 
cattle  in  the  neighborhood.3  She  died  two  days  after  admission  to  a 
hospital.  Another  Texas  victim  was  a  dairyman  who  contracted  the 
internal  form  of  the  disease  from  a  cow  and  died  on  the  eighteenth  day.3 

During  the  first  decade  of  the  present  century  five  States  passed 
laws  for  the  reporting  of  anthrax,  among  other  infectious  diseases. 
These  States  are  Massachusetts  and  Illinois  (1907),  Pennsylvania 
and  California  (1909),  and  New  York  (1910).  In  Massachusetts  be- 
tween August  1,  1907,  and  the  end  of  1909  nine  cases  were  reported, 
seven  of  which  occurred  in  Lynn,  an  important  center  of  the  leather 
and  shoe  industry.  The  fatal  cases  recorded  are  somewhat  more  nu- 
merous. Between  1865  and  1906,  for  example,  a  period  of  41  years, 
128  deaths  from  anthrax  were  recorded  in  Massachusetts  alone.4  The 
United  States  registration  area  in  1900,  the  first  year  for  which 
deaths  from  anthrax  were  listed  separately,  included  only  40.5  per 
cent  of  the  country's  population,  and  in  1909  had  increased  only 
enough  to  cover  56.1  per  cent  of  the  population.     Yet,  in  this  re- 

1  Transactions  of  Philadelphia  Academy  of  Surgery,  1005,  p.  76. 

2  A  few  years  later  the  Philadelphia  Municipal  Hospital  and  at  least  one  progressive 
manufacturer  began  to  keep  Sclavo's  serum. 

3  H.  A.  Barr  :  Report  of  Two  Fatal  Cases  of  Anthrax,  in  Texas  Medical  News,  1905-6, 
Vol.  XV,  pp.  277-281. 

*U.  S.  Public  Health  Reports,  Dec.  15,  1916,  p.  3399. 
42S060— Bull.  205—17 3 


32  BULLETIN    OF    THE   BUREAU    OF    LABOR   STATISTICS. 

stricted  area  227  fatal  cases  of  anthrax  were  recorded  for  the  10-year 
period.    Deaths  from  this  disease  have  steadily  increased  in  number. 
RECENT  EXPERIENCE. 

EXPERIENCE  OF  A  LEADING  MOROCCO-LEATHER   CENTER. 

A  Delaware  city,  for  two  generations  the  center  of  the  morocco- 
leather  industry  in  this  country,  furnished  a  favorable  opportunity 
for  a  community  study  of  occupational  anthrax.  Most  of  the  im- 
ported goatskins  come  dry  in  immense  burlap-covered  bales,  weigh- 
ing often  more  than  1,000  pounds  each,  from  goat-eating  countries, 
including  China,  India,  Arabia,  North  Africa,  Brazil  and  other 
parts  of  South  America,  Mexico,  Spain,  Macedonia,  and  Russia.1 
These  untanned  skins  formerly  came  by  steamer  to  New  York,  pre- 
sumably under  United  States  consular  certificate  to  the  effect  that 
the  foreign  agents  of  this  Government  "  have  not  required  disinfec- 
tion under  quarantine  regulations  because  the  shippers  have  declared 
that  anthrax,  rinderpest,  and  foot-and-mouth  disease  do  not  prevail 
in  the  districts  in  which  the  skins  originate." 2  The  usual  practice 
has  been  to  reship  the  skins,  by  smaller  boats,  from  New  York  to 
Philadelphia  and  then  again,  sometimes  by  still  smaller  vessels, 
to  the  Delaware  city.  Cargoes  are  now  frequently  shipped  by  train 
from  New  York,  and  recently  the  urgent  demand  has  resulted  in 
some  railroad  shipments  direct  from  the  Pacific  coast. 

Upon  arrival  at  the  company's  warehouse  the  skins  are  unloaded, 
sorted,  and  hauled  as  needed  to  the  factory,  where  they  are  dumped 
into  tanks  of  water  to  soak  for  24  hours.  When  softened  they  are 
drawn  out  and  churned  in  large  drums  which  separate  from  the 
skins  the  most  easily  dislodged  particles  of  waste  matter.  Next 
they  are  thrown  into  a  second  series  of  vats  and  immersed  for  two 
weeks  in  a  solution  of  lime  and  arsenic  or  other  agents  which  loosen 
the  hair.  These,  the  preliminary  processes  of  handling  and  pre- 
paring the  skins,  menace  the  worker  with  the  greatest  danger  of 
infection  because  the  anthrax  bacilli  and  spores  have  not  yet  been  re- 
duced in  number  or  virulence  by  the  later  tanning  processes.  On 
the  contrary,  each  process  preceding  that  of  liming  is  well  adapted 
to  cause  the  anthrax  germ  to  flourish. 

At  other  tanneries  the  especially  dangerous  preliminary  processes 
are  similar  to  those  just  described,  differing  principally  with  the 
kind  of  skins  or  hides  to  be  manufactured  into  leather.  The  tanners 
regard  the  danger  as  slight  after  the  pelts  have  passed  through  the 
liming  process.  That  the  danger,  though  in  diminished  degree,  con- 
tinues through  later  processes  is  indicated  by  occasional  outbreaks  of 
the  infection  among  the  beamers,  fleshers,  and  splitters.  The  story 
is  told  of  an  engineer  who  came  from  another  city  to  install  a  new 

1  As  a  by-product  one  company  sells  in  this  country  about  $200,000  worth  of  go.it  hair 
yearly  to  be  made  into  blankets  or  carpets  according  to  grade.  This  spreads  danger  of 
Infection  to  other  establishments  and  to  other  communities. 

2  Copied  in  April,  1916,  from  a  consular  certificate  from  Hankow,  China. 


ANTHRAX   AS   AN    OCCUPATIONAL  DISEASE.  33 

mechanical  device  in  a  Delaware  morocco  factory  and  who  contracted 
anthrax  when  he  bruised  his  hand  while  working  among  scraps  of 
waste  material  on  the  floor  beneath  the  old  machine.  But  in  this 
Delaware  city,  as  among  tanneries  elsewhere  considered  in  this  report, 
most  of  the  cases  of  anthrax  have  occurred  among  the  handlers  and 
sorters  of  imported  dry  skins  in  the  receiving  warehouses. 

One  physician  in  this  morocco-leather  center,  who  has  in  recent 
years  been  most  frequently  called  upon  by  the  manufacturers  to  treat 
victims  of  the  dread  disease,  furnished  to  the  investigator  the  names 
and  descriptions  of  48  cases  of  human  anthrax  treated  in  his  prac- 
tice during  the  past  six  years.  All  but  half  a  dozen  of  these  were 
from  the  receiving  warehouse  of  one  morocco-leather  factory.  This 
physician  reports  that  only  three  of  his  cases  resulted  fatally.1  The 
infection  in  the  majority  of  cases  was  on  the  face  or  neck.  In  a  few 
cases  it  was  on  the  shoulder,  arm,  hand,  abdomen,  or  thigh.  One 
patient  reinfected  himself  from  the  back  of  his  neck  to  his  cheek. 
Another  suffered  two  attacks,  first  on  the  neck  and  then,  nine  months 
later,  on  the  arm.  In  no  instance  was  the  disease  contracted  from  a 
previously  existing  case  in  a  human  subject. 

Other  physicians  interviewed  gave  meager  accounts  of  their 
anthrax  experiences,  speaking  largely  from  memory,  aided  as  to 
names  and  dates  by  their  cash  accounts  with  leather  manufacturers. 
All  referred  to  a  local  company  physician,  now  several  years  de- 
ceased, as  having  treated  the  greatest  number  of  cases  of  anthrax. 
According  to  his  widow,  who  had  acted  as  his  drug  clerk  and  was 
familiar  with  his  practice  for  20  years,  he  often  had  as  many  as 
four  or  five  such  cases  at  a  time. 

Local  hospitals,  on  the  plea  that  they  are  "  not  equipped,"  refuse 
to  receive  anthrax  patients,  although  a  nurse  in  charge  of  a  private 
institution  cared  for  two  or  three  such  patients  several  years  ago, 
and  one  of  these,  a  serious  case,  is -reported  to  have  been  sent  to  the 
hospital  by  a  physician  under  the  mistaken  impression  that  the 
workman  was  suffering  with  erysipelas.2  One  untrained  woman  told 
the  investigator  that  she  had  nursed  four  cases,  including  her  own 
son,  in  a  room  of  her  boarding  house,  much  to  the  consternation  of 
the  other  lodgers,  whose  fear  of  the  disease  made  them  reluctant  to 
pass  through  the  sick  room  on  their  way  to  their  own'  bedchambers.3 

1  For  methods  of  treatment  followed  by  this  experienced  physician  and  by  others  in  the 
same  city,  see  p.  17. 

2  The  refusal  of  hospitals  to  admit  cases  of  anthrax  seems  not  to  be  confined  to  Del- 
aware. R.  L.  Moore,  of  Elkland,  Pa.,  states :  "  In  one  case  which  proved  fatal  the 
physician  in  charge  was  away,  and  a  long  automobile  ride  was  necessary  to  teach  the 
nearest  hospital.  On  being  refused  admission  there,  the  patient  was  taken  on  an  all-nlgbt 
trip  to  the  nearest  physician  who  was  acquainted  with  the  disease.  Although  he  was 
in  fair  condition,  it  was  too  late  to  save  the  patient."  (Journal  American  Leather 
Chemists'  Association,  July,  1916,  p.  342.) 

8  The  ghastly  appearance  of  some  of  the  anthrax  patients,  with  beads  swollen  until 
their  features  practically  disappear,  is  terrifying  to  their  friends  and' leaves  an  impression 
not  quickly  forgotten. 


34  BULLETIN"    OF    THE   BUREAU    OF   LABOR   STATISTICS. 

This  untrained  nurse,  whose  personal  dread  of  the  disease  led  her  to 
don  gloves  and  a  mask,  was  of  the  greatest  assistance  to  the  physician 
in  bringing  back  to  health  these  patients,  one  of  whom  suffered  two 
attacks  within  a  year.  "  I  ran  the  additional  risk  of  losing  my 
boarders  and  lodgers,"  said  this  woman,  "  but  the  hospitals  wouldn't 
take  anthrax  patients.     What  else  could  I  do  ?  " 

Conversations  with  morocco  workers'  families  brought  out  the  fact 
that  fear  of  this  disease  was  common,  and  this  fact  probably  in- 
fluenced the  State  board  of  health  in  issuing  strict  orders,  which  went 
into  effect  April  1,  1915,  placing  anthrax  on  the  list  of  infectious 
diseases  to  be  quarantined.  The  quarantine  placards,  printed  by  the 
State  and  posted  by  the  city  health  officials,  read  as  follows : 


This  notice  must  be  tacked  on  the  front  door. 
ANTHRAX. 

Until  this  notice  is  legally  remoTed  all  persons 
not  occupants  of  these  premises  are  forbidden  to 
enter,  and  no  person  must  leave  this  house  or  re- 
move any  article  except  by  permission  of  the  health 
authorities. 


It  is  also  required  that  every  house  in  which  a  case  of  anthrax 
has  occurred  or  exists  shall  be  "  completely  disinfected "  upon  the 
recovery,  death,  or  removal  from  such  house  of  the  patient.  Quar- 
antine shall  be  continued  for  14  days  after  disinfection. 

At  the  work  places  precautions  against  infection  from  materials 
handled  are  not  elaborate.  At  only  one  warehouse  was  a  warning 
notice  found  posted.    It  was  in  two  languages  and  read  as  follows : 


NOTICE   TO   EMPLOYEES. 


Use  soap,  water,  flesh  brush,  and  towels  liber- 
ally. 

Rinse  your  hands  in  bucket  of  disinfectant  before 
drying  on  towels. 

Give  special  attention!  to  finger  nails,  always 
keep  them  short  and  clean. 

Do  not  scratch  or  pick  any  broken  surface  of 
the   skin. 

Report  to  office  any  form  of  sickness,  cuts,  acci- 
dents, bruises,  pimples,  or  sores,  for  immediate  at- 
tention. 

See  that  dressing  rooms,  washbasins,  and  toilets 
are  kept  clean,  and  report  to  foreman  any  violation 
of  above  rules,  for  joxxr  own  protection. 

Caution  all  new  employees. 

Working  gloves  may  be  obtained  at  office. 


ANTHKAX  AS  AN"   OCCUPATION" AL  DISEASE.  35 

Universal  was  the  testimony  that  the  workers  paid  little  or  no 
attention  to  written  or  verbal  warnings  except  as  the  foreman  or 
superintendent  with  watchful  eye  detected  an  abrasion  of  the  skin 
or  a  suspicious  looking  "  pimple "  and  personally  required  the  use 
of  a  disinfectant.  It  was  commonly  stated  that  in  conformity  with 
the  requirements  of  the  local  health  officials  a  supply  of  bichloride 
of  mercury  was  constantly  kept  in  readiness  for  disinfecting  pur- 
poses. At  three  of  the  warehouses  visited,  special  inquiry  was 
made  for  the  disinfectant,  and  in  two  cases  bottles  of  bichloride 
of  mercury  tablets  were  shown  at  the  office,  once,  however,  with  the 
bottle  unopened  and  thickly  covered  with  dust,  while  at  the  third 
warehouse  the  foreman,  with  some  embarrassment  and  after  a  per- 
functory search,  remarked  that  he  believed  the  tablets  had  been 
borrowed  by  the  factory  in  the  next  block.  In  the  same  warehouse 
there  was  one  sink  with  a  single  faucet  and  one  piece  of  soap  for 
the  ablutionary  convenience  of  the  workmen,  but  it  was  admitted 
that  no  warm  water  was  available  even  in  winter.  "  The  men  all 
wear  gloves  at  their  work,"  said  the  foreman.  Careful  inspection 
half  an  hour  later,  however,  disclosed  six  out  of  eight  skin  sorters 
and  truckers  in  a  near-by  corner  working  with  hands  unprotected. 
"  Well,  they  wear  gloves  in  the  winter,"  was  the  foreman's  amend- 
ment. 

Very  general  was  the  opinion  among  physicians  and  laymen  that 
hides  and  skins  imported  from  districts  where  anthrax  is  prevalent 
should  be  disinfected  before  they  are  landed  in  this  country.  One 
official  of  a  tannery  company,  however,  complained  that  the  Federal 
Government,  during  the  preceding  week,  had  required  them  to  dis- 
infect 700  hides,  at  a  cost  of  $120,  because  the  hides  had  come 
through  without  a  consular  certificate  from  the  country  of  ship- 
ment to  the  effect  that  certain  diseases,  including  anthrax,  were  not 
prevalent  at  the  time. 

CASES  REPORTED  UNDER  NEW  YORK  OCCUPATIONAL  DISEASE  REPORTING  LAW. 

*  The  New  York  occupational  disease  reporting  law1  went  into 
effect  on  September  1,  1911,  and  between  that  date  and  March  31, 
1916,  23  cases  of  anthrax,  13  of  which  were  fatal,2  were  reported 
to  the  State  department  of  labor.  Nearly  twice  as  many  of  the  total 
number  of  cases  (15  out  of  23)  and  three  times  as  many  of  the 
fatal  cases  (10  out  of  13)  occurred  in  the  last  12  months  as  during 
the  entire  preceding  period  of  43  months  since  the  law  became  opera- 
tive. This  increase  is  probably  due  in  part  to  more  active  compliance 
of  physicians  with  the  law,  but  as  it  coincides  with  large  increases  in 

iNew  York,  Laws  of  1911,   ch.  258. 

2  For  detailed  accounts  of  12  of  these  cases  which  occurred  prior  to  1916,  see  pp. 
GO  to  78. 


36  BULLETIN"   OF    THE   BUREAU    OF    LABOR   STATISTICS. 

the  number  of  cases  treated  by  hospitals  in  other  States,  as  will 
later  be  shown,  there  can  be  little  doubt  that  it  is,  in  the  main, 
indicative  of  a  real  and  startling  growth  in  the  prevalence  of  the 
disease.  Eight  of  the  cases  were  reported  from  New  York  City, 
including  Brooklyn;  four  from  Gloversville,  the  center  of  the 
American  glove  industry ;  four  from  Endicott,  where  there  are  large 
tanneries  and  shoe  shops;  and  one  from  each  of  seven  other  cities 
and  towns.  Twenty  of  the  patients  were  males,  while  three  were 
females.  Half  of  them  were  between  the  ages  of  41  and  60;  the 
"youngest  was  a  little  girl  of  6 ;  the  oldest  a  retired  lawyer  of  71. 

The  occupational  group  most  largely  represented  was  the  hide, 
skin,  and  leather  workers,  of  whom  there  were  10  (4  of  whom 
died),  including  6  employees  of  hide  tanneries,  3  workers  on  sheep- 
skins, and  1  shoemaker.  The  shoemaker  was  employed  in  a  large 
factory  and  may  have  contracted  the  disease  from  an  infected 
hide  in  which  the  spores  had  survived  the  tanning  processes.1  The 
workers  on  sheepskins  are  described,  respectively,  as  "washer  of 
sheepskins,"  "  trimming  sheepskins,"  and  "  limer  and  general  helper," 
who  had,  however,  just  before  infection,  been  "helping  store  away 
raw  sheepskins."  Among  the  hide-tannery  employees  were  one  beam 
hand,  two  who  apparently  worked  in  a  freight  gang  conveying  green 
hides  to  one  tannery  only,  two  whose  exact  occupation  was  not  stated, 
and — worthy  of  special  note — one  steam  fitter.  -A  second  occupa- 
tional group  was  the  transportation  workers,  represented  by  three 
cases  (two  fatal).  One  was  a  dock  laborer,  one  a  baggage-master  on 
a  dock,  and  one  a  driver.  There  were  three  farmers  (two  of  whom 
died) ,  and  one  from  each  of  the  following  callings :  "  Laborer  in  skin 
mill — drying  sheep  wool,"  spinner  in  rug  mill,  veterinarian,  candy 
packer,  and  lawyer ;  two  were  not  engaged  in  industry.  There  were, 
therefore,  at  least  seven  persons,  and  possibly  nine,  who  became  in- 
fected through  the  transportation  and  early  treatment  of  hides  and 
skins  before  actual  tanning  was  begun.  The  rug-mill  employee  had 
a  pustule  on  the  thumb  "  following  scratch  from  piece  of  tin  on  floor 
of  spinning  room";  anthrax  bacilli  were  fcund.  The  veterinarian 
was  infected  while  vaccinating  cows,  suffering  from  anthrax,  on  three 
up- State  farms.  One  farmer,  who  died,  is  believed  to  have  caught  the 
disease  from  a  sick  cow  which  he  slaughtered  and  dressed  for  beef.2 

1  See  p.  20.  2  See  fatal  case  No.  78,  p.  71. 


ANTHRAX   AS   AN    OCCUPATIONAL   DISEASE. 


37 


Table  1.— CASES  OF  ANTHRAX  REPORTED  TO  THE  NEW  YORK  STATE  DEPARTMENT 
OF  LABOR  UNDER  THE  OCCUPATIONAL  DISEASE  REPORTING  LAW,  SEPTEMBER, 
1911,  TO  MARCH,  1916. 


September 
to  Decem- 
ber, 1911. 

1912 

1913 

1914 

1915 

January 

to  March, 

1916. 

Total. 

Occupation. 

Cases 
re- 
port- 
ed. 

Fatal 
cases. 

Cases 
re- 
port- 
ed. 

Fatal 
cases. 

Cases 
re- 
port- 
ed. 

Fatal 
cases. 

Cases 
re- 
port- 
ed. 

Fatal 
cases. 

Cases 
re- 
port- 
ed. 

Fatal 
cases. 

Cases 
re- 
port- 
ed. 

Fatal 
cases. 

Cases 
re- 
port- 
ed. 

Fatal 
cases. 

Hide,  skin, 
and  leather 

1 
1 

1 

1 

1 

1 

4 

2 
2 

2 

2 

1 

3 

10 

3 
3 
1 

4 

T  r  a  n  spolia- 
tion workers. 

0 

1 
1 

1 

2 

Veterinarians  . 

Miscellaneous. 

1 

2 

2 
2 

1 

1 

4            3 

Not  in  indus- 

2 

2            2 

Total... 

2 

1 

3 

2 

1 

1 

12 

9 

4 

1 

23 

13 

None  of  the  cases  is  specified  as  having  been  internal.  Eight  of 
the  lesions  were  on  the  face,  four  on  the  neck,  three  on  the  hand, 
two  on  the  arm,  two  on  the  chest,  two  on  the  hip,  one  on  the  leg,  and 
one  not  stated.  In  eight  cases  anthrax  bacilli  were  actually  found, 
either  in  cultures  from  blood  serum  or  by  post-mortem  examination 
of  the  organs,  and  six  of  the  cases  in  which  bacilli  were  found  resulted 
fatally.  On  two  patients  antianthrax  serum  was  used;  one  of  these 
recovered.1 

The  result  of  applications  filed  in  certain  of  these  cases  for  indem- 
nity under  the  New  York  workmen's  compensation  law  is  taken  up  on 
p.  92. 

CASES  REPORTED  UNDER  NEW  JERSEY  OCCUPATIONAL  DISEASE  REPORTING  LAW. 

The  law  requiring  the  reporting  of  occupational  diseases  in  New 
Jersey  2  was  passed  a  year  later  than  the  New  York  statute,  the  .re- 
sults of  which  have  just  been  described,  and  went  into  effect  on  July  4, 
1912.  The  State  board  of  health,  to  whom  reports  are  to  be  sent, 
states  that  from  that  date  to  May  1,  1916,  it  received  13  certificates 
regarding  cases  of  anthrax,  all  but  one  of  which  arose  in  the  city  of 
Camden,  the  seat  of  extensive  leather,  kid,  and  morocco  works.  The 
remaining  patient  was  a  feed  merchant  in  a  small  town,  whose  infec- 
tion, his  physician  thinks,  may  have  been  "  due  to  carrying  bags  of 
feed  on  shoulder." 

1  In  addition  to  the  23  cases  here  discussed,  reports  of  human  anthrax  in  New  York 
State  have  been  obtained  from  reliable  sources,  as  follows :  1911 — New  York  City,  assorter 
and  packer  of  ready-made  clothing,  aged  30,  treated  at  hospital ;  recovered.  1915 — New 
York  City,  Government  weigher  handling  hides,  aged  34,  died;  New  York  City,  medical 
student,  aged  25,  died;  Saratoga  Springs,  farmer,  contracted  disease  by  performing 
autopsy  on  cow,  outcome  not  learned.  1916 — New  York  City,  hide  handler,  employed  by 
importer,  aged  39,  treated  at  hospital,  recovered  ;  New  York  City,  fruit  company  employee, 
aged  16,  died ;  Endicott,  tannery  laborer,  handling  dry  hides,  recovered ;  Utica,  cattle 
dealer  and  butcher,  outcome  not  learned.  Further  details  of  the  two  fatalities  in  1915 
will  be  found  on  pp.  75  and  78. 

2  New  Jersey,  Laws  of  1912,  ch.  351. 


38  BULLETIN    OF    THE   BUREAU    OF    LABOB    STATISTICS. 

Only  one  of  the  13  cases  was  fatal— that  of  a  receiver  and  checker 
of  Russian  horsehides.  All  the  patients  were  men  ranging  from 
21  to  55  years  of  age;  7,  or  more  than  half  of  the  total  number, 
were  between  the  ages  of  21  and  30.  Four  of  the  lesions  were  on 
the  neck,  two  were  on  the  face,  and  two  were  on  the  arm.  "  Infected 
part  resembled  a  typical  vaccination,  except  black,"  says  the  physi- 
cian of  one  of  these.  In  another  case  the  form  of  the  disease  is 
stated  as  external,  but  the  location  is  not  given;  in  the  remaining 
four  cases  the  form  is  not  stated,  but  since  the  patients  recovered  it 
was  probably  external  in  these  also.  In  only  one  case  is  the  finding 
of  anthrax  bacilli  reported ;  100  c.  c.  of  antianthrax  serum  were  used, 
and  recovery  followed.  Three  other  patients  who  recovered  were 
also  treated  with  serum,  one  being  given  10  c.  c.  and  another  "  about 
eight  injections,"  while  the  third  "  had  20  injections  of  antianthrax 
serum,  200  c.  c." 

The  occupations  are  known  for  nine  of  the  patients  in  addition  to 
the  feed  merchant,  and  all  but  one  of  these  were  in  contact  with  hides 
and  skins.  Three  were  engaged  at  the  same  leather  works,  one  as 
a  "  checker  and  receiver  of  incoming  horsehides "  imported  from 
Russia,  one  as  a  "  stock  assorter,  examining  hides  and  skins,"  and  the 
third  at  "  assorting  and  handling  hides."  Of  three  men  employed 
in  a  single  kid  shop  two  are  designated  only  as  kid  or  morocco  work- 
ers, while  one  was  a  wool  washer.  A  patient  from  another  kid  plant 
handled  wet  raw  skins,  while  a  stationary  fireman  in  still  another 
factory  of  this  class  contracted  the  disease  after  acting  for  the  "  last 
few  months  as  sorter  of  raw  hides  from  Mexico  and  Central  America." 
The  ninth  man  of  this  group  was  a  teamster,  and  had  helped  load 
trucks  with  Russian  sheepskin.  Thus,  at  least  six  of  these  men  were 
infected  by  raw  skins  during  their  transportation  to  and  receiving 
and  sorting  at  the  tanneries.1 

CASES  REPORTED  UNDER  PENNSYLVANIA  INFECTIOUS  DISEASE  REPORTING  LAW. 

In  Pennsylvania  under  the  infectious  disease  reporting  law  49 
cases  of  anthrax  were  reported  in  the  three  years  between  January  1, 
1913,  and  January  1, 1916.  Eight  of  the  sufferers,  including  two  hair 
sorters  and  a  tannery  hand,  were  females.  Nearly  one-half  of  the 
cases,  or  23,  occurred  in  1913,  and  10  of  these  were  in  the  city  of 
Philadelphia,  one  of  the  centers  of  the  glazed-kid  industry.  All  of 
the  six  cases  reported  in  the  first  half  of  1914  also  came  from  Phila- 
delphia, thus  making  for  that  city  a  total  of  16  cases  in  18  months. 

1  Additional  anthrax  cases  reported  to  the  New  Jersey  department  of  health  under  the 
preventable  disease  notification  law  (Laws  of  1911,  ch.  381)  are:  1912 — Camden,  occu- 
pation not  given,  recovered  ;  Camden,  handler  of  imported  hides,  recovered ;  place  and 
occupation  not  given,  recovered ;  place  and  occupation  not  given,  died.  1914 — Cam- 
den, occupation  not  given,  recovered  ;  two  cases,  place  and  occupation  not  given,  died. 
1915 — Two  cases,  place  and  occupation  not  given,  died.  Record  has  also  been  secured 
of  a  tannery  worker  who  recovered  under  serum  treatment  at  a  Newark  hospital  early 
in  1916. 


ANTHRAX    AS    AN    OCCUPATIONAL   DISEASE. 


39 


Here,  as  in  the  two  States  whose  experience  with  anthrax  under 
occupational  disease  reporting  laws  has  been  described,  the  occu- 
pational group  most  largely  represented  is  hide  and  skin  workers. 
Five  were  given  as  tannery  employees,  two  as  leather  workers,  one  as 
a  raw  hide  sorter,  and  one  as  a  skin  washer.  Most  of  the  12  classed 
as  laborers  were  also,  it  is  reported,  employed  by  tanneries.  There 
were  eight  hair  workers,  of  whom  one  was  a  haircloth  examiner,  two 
were  sorters,  and  one  a  brush  maker ;  a  ninth  case  is  given  as  "  a  car 
builder  who  might  be  included  as  a  hair  worker."  There  were  two 
longshoremen,  and  one  from  each  of  the  following  callings:  Wool 
handler,  "raw  stock"  inspector  (without  designation  of  the  kind  of 
stock),  liveryman,  teamster,  merchant,  carpenter,  and  roofer.  Two 
were  infants  1  year  and  10  months  old,  respectively,  the  father  of  one 
being  a  tanner  and  of  the  other  a  coal  miner.  In  eight  cases  the 
occupation  is  not  stated. 

At  least  7  of  the  27  cases  reported  during  the  first  18  months 
are  known  to  have  been  fatal,  and  are  discussed  more  in  detail  in  the 
section  on  anthrax  fatalities  reported  in  the  United  States  registra- 
tion area.  A  number  of  the  nonfatal  cases  were  treated  in  a  Philadel- 
phia hospital  and  are  considered,  together  with  other  cases  at  the 
same  hospital,  in  the  next  section. 

CASES   ON   RECORD   IN   A   PHILADELPHIA   HOSPITAL. 

One  Philadelphia  contagious-disease  hospital  reports  a  total  of  32 
cases  (6  fatal)  from  January  1,  1909,  to  April  30,  1916.  The  great 
majority  of  the  patients  in  these  cases  were  men,  only  three — a  hair 
sorter,  a  hair  twister,  and  one  other  hair  worker — being  women ;  all  of 
the  six  deaths  occurred  among  men.  The  patients  were  all  residents 
of  Philadelphia.  Their  prevailing  age  was  markedly  lower  than  that 
of  the  cases  reported  in  New  York  State,  12  of  them  being  between 
the  ages  of  31  and  40,  and  10  between  21  and  30;  the  youngest  was  a 
woman  hair  sorter  aged  19,  and  the  oldest  a  haircloth  inspector  of  67. 
The  distribution  of  these  cases  by  years  and  by  occupations  was  as 
follows : 

Table  3.— CASES  OF  ANTHRAX  RECORDED  BY  A  PHILADELPHIA  HOSPITAL,  JAN.  1, 

1909,  TO  APR.  30,  1916. 


1909  to  1911 

1912 

1913 

1914 

1915 

Jan.  1 

to  Apr.  30, 

1916 

Total. 

Occupation. 

Cases 
re- 
port- 
ed. 

Fatal 
cases. 

Cases 
re- 
port- 
ed. 

Fatal 
cases. 

Cases 
re- 
port- 
ed. 

Fatal 
cases. 

Cases 
re- 
port- 
ed. 

Fatal 
cases. 

Cases 
re- 
port- 
ed. 

Fatal 
cases. 

Cases 
re- 
port- 
ed. 

Fatal 
cases. 

Cases 
re- 
port- 
ed. 

Fatal 
cases. 

Hide   and 

2 

3 
1 
1 

1 

3 
4 

1 

1 
5 

1 

3 

1 

1 

3 

1 
2 

10 

17 
2 

1 

3 

Wool  and  hair 

2 
1 

3 

Longshoremen 

1 

O  c  c  u  pation 
not  reported. 

; 

Total... 

8    7 

1           6 

1 

4 

1 

3 

4 

3 

32  |          G 

40  BULLETIN"   OF    THE   BUREAU    OF    LABOR   STATISTICS. 

It  will  be  noticed  that  the  rate  of  one  case  per  month  with 
which  1916  began  is  nearly  double  the  next  highest  rate,  that  for 
1912,  during  which  year  seven  cases  were  recorded.  The  increase  in 
fatal  cases  is  still  more  striking,  as  many  having  occurred  in  the 
first  four  months  of  1916  as  in  all  the  preceding  seven  years.1 

The  largest  number  of  patients  were  workers  in  wool  or  hair,  due 
no  doubt  to  the  local  prominence  of  this  industry.  Seventeen,  three 
of  whom  died,  were  in  this  group,  which  covered  a  particularly  wide 
range  of  processes.  Thus  there  were  four  hair  sorters,2  one  wool 
sorter,  one  hair  picker,  one  hair  twister,  three  hair  spinners,  one  wool 
teamster,  and  four  laborers  in  wool  or  hair  plants  (duties  not  differ- 
entiated) ;  even  men  comparatively  remote  from  danger  contracted 
the  infection,  as  witness  a  haircloth-loom  fixer  and  a  haircloth  in- 
spector. One  of  the  hair  sorters  worked  in  a  horsehair  factory; 
the  hair  picker  and  at  least  one  of  the  hair  spinners  were  employed 
in  a  single  curled-hair  plant.  The  group  next  most  largely  repre- 
sented is  that  of  the  hide  and  skin  workers,  of  whom  there  were  10 
(three  of  whom  died).  One  was  a  hide  sorter,  one  a  hide  washer, 
and  one  a  sorter  of  raw  stock  in  a  glazed-kid  factory,  while  the 
precise  process  carried  on  by  seven  tannery  workers  is  not  given. 
Two  sufferers  from  the  disease  were  longshoremen,  and  in  both  cases 
the  hospital  records  state  that  for  some  days  previous  to  the  attack 
the  men  had  been  unloading  hides.  Of  the  two  classified  in  the  table 
as  "  miscellaneous,"  one  was  a  shoddy  worker  who  may  easily  have 
contracted  anthrax  from  the  dirty  rags  he  handled ;  the  other  was  a 
glue-factory  hand  who  may  have  got  it  from  hoofs  or  other  parts 
of  a  diseased  animal,  although  the  hospital  record  further  states  that 
he  "  occasionally  handled  leather."  In  only  one  case  among  this 
valuable  set  of  records  is  the  occupation  not  stated.  Throughout,  the 
connection  between  occupation  and  contagion  is  much  closer  than 
in  the  New  York  series. 

In  all  of  the  cases  recorded  by  this  hospital  the  disease  took  the 
external  form.  The  pustule  occurred  in  19  cases  on  the  face  and  in  10 
cases  the  neck,  the  six  deaths  being  distributed  equally  between  these 
two  groups.  Three  lesions  were  on  the  arm,  and  one  on  the  hand; 
one  case  is  noted — that  of  a  girl  hair  sorter — in  which  lesions  ap- 
peared both  "  on  jaw  and  wrist." 

Due  to  the  care  with  which  these  records  were  kept,  valuable  data 
regarding  the  duration  of  anthrax  attacks  are  available.  The  six 
cases  with  the  shortest  duration — ranging  from  three  to  eight  days 

iOn  Apr.  11,  1916,  Chief  Medical  Inspector  Cairns,  of  Philadelphia,  stated  that  from 
10  to  12  cases  of  anthrax  developed  in  Philadelphia  annually  and  that  "  already,  in  1916, 
four  deaths  have  resulted  from  the  malady." 

2  One  of  these,  who  contracted  the  disease  in  1916,  filed  a  claim  for  compensation, 
which  was  denied  on  the  ground  that  infection  had  not  taken  place  through  a  "  wound  or 
other  unusual  incident."     (See  p.  92.) 


ANTHRAX   AS  AN    OCCUPATIONAL   DISEASE. 


41 


after  appearance  of  the  first  symptoms — were  all  fatal,  and  these 
were  the  only  cases  which  so  resulted.  The  next  shortest  case  termi- 
nated in  recovery  and  discharge  from  the  hospital  on  the  seventeenth 
day  of  the  disease.  The  most  protracted  illness  lasted  for  51  days. 
The  duration  of  illness  and  number  of  cases  of  death  were  as  follows : 


Table  3. 


-DURATION   OF  ILLNESS,  AND  DEATHS  AMONG   32  CASES  OF  ANTHRAX  IN 
A  PHILADELPHIA  HOSPITAL. 


Duration  of  illness. 

Cases. 

Deaths. 

5 
1 
5 
8 
4 
5 
3 
1 

5 

1 

9,  and  under  3  wpbVs     

3  and  under  4  weeks 

4  and  under  S  weeks   , 

6  and  under  7  weeks 

Total 

32 

6 

In  the  overwhelming  majority  of  cases,  22  out  of  32,  treatment 
was  by  excision  and  serum;  of  these,  three  died.  In  five  cases  ex- 
cision alone  was  performed,  and  two  deaths  resulted.  One  man  was 
brought  to  the  hospital  moribund  and  neither  method  was  applied; 
he  died  eight  hours  later.  In  four  cases  the  mode  of  treatment  was 
not  reported.1 

CASES  ON  RECORD  IN  A  MASSACHUSETTS   HOSPITAL. 

The  records  of  one  Massachusetts  hospital  show  35  cases  of  an- 
thrax between  June  27,  1881,  and  April  26,  1916.  Of  these  6  were 
fatal,  26  were  nonfatal,  and  3  patients  were  still  in  the  wards  at 
the  time  of  the  investigation.  The  recent  increase  in  prevalence 
revealed  by  the  New  York  and  Pennsylvania  reporting  laws  is 
here  paralleled.  The  number  admitted  during  the  first  three  months 
and  26  days  of  1916  (9  out  of  the  35)  is  thrice  that  admitted 
in  1915,  and  equals  the  number  treated  during  the  whole  period 
1881-1904,  inclusive.2  The  largest  number  of  cases  from  single  cities 
came  from  Boston  (5),  Woburn  (5),  and  Winchester  (4) ;  five  other 
towns  in  the  vicinity  of  Boston  sent  2  cases  each,  and  11  towns  1 
case  each.     Only  1  of  the  35  patients  was  a  woman.     Fifteen  were 

1  The  numerous  instances  of  death  from  anthrax  in  Philadelphia  was  one  of  the  rea- 
sons given  for  the  establishment  during  the  summer  of  1916  of  the  clinic  for  occupational 
diseases  at  the  University  of  Pennsylvania  Hospital  in  that  city. 

2  The  total  number  of  cases  reported  in  the  State  during  the  first  half  of  1916  was 
25.  "This  was  the  severest  outbreak  of  this  disease  ever  recorded  in  Massachusetts." 
Twenty  of  the  cases  occurred  in  three  tanneries  and  were  traced  to  a  common  source, 
a  single  cargo  of  dried  "China"  hides  from  infected  territory.  (United  States  Public- 
Health  Reports,  Dec.  15,  1916,  p.  3401.) 


42  BULLETIN   OF    THE   BUREAU    OF    LABOR    STATISTICS. 

between  the  ages  of  21  and  30,  15  were  between  31  and  5u,  2  were 
between  61  and  TO,  and  the  remaining  3  were  between  11  and  20 
years  of  age. 

Hide  and  skin  workers  made  up  nearly  half  of  the  total  number 
of  patients — 16  out  of  35.  Thirteen  of  these  were  tannery  workers, 
one  was  a  morocco  worker,  one  a  leather  worker,  and  one  a  "  laborer 
handling  raw  hides."  The  "  leather  worker  "  was  in  charge  of  men 
cutting  fresh  hides.  Of  the  tannery  employees  two  were  "  beamers," 
who  scraped  hides  and  put  them  through  rollers ;  two  split  hides ;  two 
others  took  hides  from  the  soaking  pits;  three  of  these  six  were  re- 
ported as  handling  wet  hides.  One  man  handled  hides  as  a  teamster 
for  a  tannery,  one  was  a  flesher,  one  is  designated  merely  as  "  la- 
borer" in  a  tannery;  one  was  engaged  on  sheep  and  goat  skins;  in 
the  three  remaining  cases  no  information  was  given  beyond  the 
word  "  tanner." 

Transportation  workers  were  represented  by  nine  cases,  two  fatal. 
Four  were  dock  laborers;  two  were  freight  handlers,  one  of  whom 
handled  raw  hides  and  wool ;  two  were  weighers  of  skins  and  hides ; 
and  one  was  a  teamster.  Five  patients  were  employed  in  the  wool 
and  hair  industry.  Two  were  employed  in  a  wool  factory,  one  of 
them  as  a  carder ;  in  the  other  case  the  infection  was  so  serious  that 
it  necessitated  amputation  of  the  arm  at  the  shoulder.  One  was 
an  upholsterer's  helper  and  handled  wool  used  for  stuffing.  Two 
days  before  coming  to  the  hospital  he  cut  his  neck  while  shaving; 
infection  developed  on  neck  and  chest,  and  four  days  later  "  patient 
looked  as  if  he  weighed  over  200  pounds."  One  was  a  teamster  cart- 
ing wool,  and  one  was  employed  in  a  hair  factory. 

In  addition  to  these  workers,  whose  employment  bears  a  well- 
defined  relation  to  the  disease,  two  patients  were  designated  merely 
as  laborers.  One  of  these,  however,  was  employed  in  a  soap  factory. 
Three  weeks  before  he  was  admitted  to  the  hospital,  it  is  reported, 
a  box  of  skins  was  sent  by  mistake  to  the  factory,  where  it  was 
opened  and  a  skin  was  kicked  about  by  a  fellow  workman,  striking 
the  patient  in  the  back  of  the  neck.  Rag  workers,  factory  girls,  and 
machinists  were  also  represented  by  one  case  each. 


ANTHEAX   AS   AN    OCCUPATIONAL   DISEASE. 


43 


Table  4.— CASES  OF  ANTHRAX  ADMITTED  TO  A  MASSACHUSETTS  HOSPITAL,  JUNE  27, 
1881,  TO  APR.  26,  1916,  BY  OCCUPATIONS. 


June  27,1881, 
to  Dec.  31,  :         1912 
1911 

1913 

1914 

1915 

Jan.  1  to 

Apr.  26,     !       Total. 
1916 

Occupation. 

Cases 
re- 
port- 
ed. 

Fatal 
cases. 

Cases 
re- 
port- 
ed. 

Fatal 
cases. 

Cases 
re- 
port- 
ed. 

Fatal 
cases. 

Cases 
re- 
port- 
ed. 

Fatal 
cases. 

Cases 
re- 
port- 
ed. 

Fatal 
cases. 

Cases 
re- 
port- 
ed. 

Fatal 
cases. 

Cases 
re- 
port- 
ed. 

Fatal 
cases. 

Hide  and  skin 

5 

3 

4 
5 

1 

1 
2 

2 
1 

2 

1 

7 

16 
5 
9 

1 

Wool  and  hair 

1 

1 

Trans  porta- 

2 

1 

2 

1 

2 

•?. 

Total... 

17 

4 

3 

2 

1 

3 

1 

9i        1 

35  |          6 

1 

The  duration  of  illness  was  short  in  the  6  fatal  cases.  One  such 
case  lasted  3  days  and  another  5  days;  3  patients  died  after  an  illness 
of  7  days  each  and  1  after  8  days.  The  shortest  of  the  nonfatal  cases 
lasted  10  days;  in  another  the  patient  was  ill  13  days;  6  lasted  be- 
tween 14  and  21  days ;  in  9  cases  the  duration  was  21  days  but  under 
28 ;  8  persons  were  ill  28  days  or  more.  Of  those  remaining,  1  was 
an  out-patient  and  3  were  still  in  the  hospital  wards  at  the  time 
of  investigation. 

The  situation  of  the  pustule  is  given  in  all  but  one  fatal  case, 
which,  according  to  the  symptoms,  was  probably  internal.  In  a 
majority  of  cases  (20  out  of  35)  the  lesion  was  on  the  neck,  9  lesions 
were  on  the  face,  and  5  were  on  the  arm  or  hand.  In  1 8  of  the  total 
number  of  cases  and  in  5  of  the  6  which  ended  fatally,  examination 
disclosed  anthrax  bacilli. 1 


CASES   REPORTED   BY   TANNERS   AND    LEATHER  MANUFACTURERS. 

In  the  course  of  preparing  this  report  the  Bureau  of  Labor  Sta- 
tistics sent  about  1,400  circular  letters  in  regard  to  anthrax  to  tanners 
and  leather  manufacturers.  To  these,  592  replies  were  received. 
Nineteen  establishments  reported  70  cases  of  anthrax  within  the 
last  two  or  three  years,  6  of  these  cases  being  fatal.2 

While  these  cases  probably  duplicate  to  some  extent  the  cases  else- 
where discussed  in  the  report,  it  is  convenient  to  present  them  to- 
gether. 

1  For  additional  records  of  Massachusetts  cases,  see  pp.  26,  27,  28,  and  89-91. 

2  At  the  same  time,  1,600  similar  inquiries  were  sent  to  wool  dealers  and  wool  manufac- 
turers, but  elicited  a  report  of  only  one  case,  that  of  a  Boston  laborer  trucking  wool,  who 
recovered  under  hospital  treatment. 


44 


BULLETIN    OF    THE   BUREAU    OF    LABOB   STATISTICS. 


Table  5.— ANTHRAX    CASES   REPORTED    BY    NINETEEN    TANNING    AND    LEATHER 
MANUFACTURING  ESTABLISHMENTS. 


Location. 

Firm. 

Occupation 
of  victim. 

Treatment. 

Result. 

Precautions  now  taken. 

Maine: 

Island  Falls . . . 

No.l.. 

Sweater    in 

At  home — local  phy- 

Full  recov- 

None. 

tannery. 

sician. 

ery. 

Massachusetts: 

North  Woburn. 

No.  2. . 

Tanner 

At  Massachusetts  Gen- 
eral Hospital. 

do 

Have  discontinued  use 
of  China  hides. 

Flesher 

At  home 

do 

Beam-house 

At  Massachusetts  Gen- 

 do 

hand. 

eral  Hospital. 

Norwood 

No.  3.. 

No  informa- 

Local physician 

do 

No  information. 

tion. 

"Woburn 

No.  4.. 

Beamster 

At  Massachusetts  Gen- 

Recovery ex- 

Daily examination  of 

eral  Hospital. 

pected. 

all  employees. 

No.  5.. 

2  cases;  oc- 

 do 

Full  recov- 

Use   solution    recom- 

cupations 

ery. 

mended  by  State  in- 

not given. 

spectors;  stoppedtan- 

1  case ... 

At  home 

do 

n  in  g  dry  China  hides . 
Carbolacitin    used    as 

No.  6. . 

5  cases;  oc- 

Some  by  local   phy- 

 do 

cupations 

sicians,  and  others 

wash  by  men,  and  in 

Michigan: 

Cheboygan 

not  given. 

at  hospitals. 

soak  pits. 

No.  7.. 

3  -  year  -  old 

Antianthrax     serum; 

do 

China  hides  put  into 

daughter 

tincture   iodine   in- 

corrosive   sublimate 

o     beam- 

jected  hypodermic- 

solution;    employees 

house  em- 

ally around  area  of 

wear     wet     sponges 

ployee. 

infection. 

over  mouth  and  nos- 

Beamster  

Antianthrax     serum 

Full  recov- 

trils when  unloading 

and  early  excision  of 

ery       (32 

these  hides. 

primary  lesion. 

days). 

Munising 

No.  8.. 

Beamster... 

Sores  washed  with  car- 

Full  recov- 

Carbolic-acid wash  kept 

bolic   acid   and   io- 

ery. 

on  hand  for  use  on 

dine;  face  and  neck 

cuts,  etc. 

washed  with  iodine, 

vitriol,    and    cam- 

phor oil;  gauze  pack 

saturated  with  boric 

acid  and  epsom  salts 

(hot  water)  applied 

to  face  for  5  days; 

ice-cold  baths  when 

fever  over  103°. 

New  Hampshire: 

Whitefield 

No.  9.. 

do 

Hospital  treatment 

do 

Disinfect  hides  in  solu- 

 do 

do 

do 

tion  of  bichloride  of 

do 

do.. 

do 

mercury    and    com- 

mon salt. 

New  Jersey: 

Camden 

No.  10. 

do 

At  home,  by  company 
physician. 

do 

Antianthrax  serum; 
solution  of  bichloride 
of  mercury  on  hand 
for  use  by  employees. 

No.  11. 

Raw  -  stock 

Diagnosed  as  anthrax 

Fatal 

Breaks  in  skin  of  em- 

depart- 

too late  to  be  treated 

ployees  in  raw-stock 

, 

ment;  dry 

for  same. 

department    cauter- 

horsehides 

ized  by  factory  doc- 
tor. 

do 

Antianthrax  serum;  in- 

Full   recov- 

jecting  20  c.  c.  every 
4  to  6  hours;  high  fre- 
quency    electricity 
and  fulguration  used 
over  primary  lesion; 
lachisis  used  inter- 
nally. 

ery(3  weeks 
4  days). 

do 

do 

Full  recov- 
ery (5  weeks 

2  days). 

No.  12. 

3  or  4  cases  in 

Antianthrax  serum 

No  informa- 

Doctor in  attendance 

raw  -  skin 

tion. 

every    morning    for 

depart- 

treatment  of  minor 

ment  or  in 

accidents. 

beam  house. 

No.  13. 

Beamster 

At  Newark  City  Hos- 

Full recov- 

Rubber gloves. 

engaged  in 

pital. 

ery. 

trimming 

hides. 

ANTHRAX    AS    AN    OCCUPATIONAL    DISEASE. 


45 


Table  5.— ANTHRAX    CASES    REPORTED    BY    NINETEEN    TANNING  AND  LEATHER, 
MANUFACTURING   ESTABLISHMENTS— Concluded. 


Location. 

Firm. 

Occupation 
of  victim. 

Treatment. 

Result. 

Precautions  now  taken 

New  York: 

Endicott 

No.  14. 

No.  15. 
No.  16. 

No.  17. 
No.  18. 

No.  19. 

Unloading 

hides. 
Repairman.. 

Handling 

hides. 
Beamster 

At  Johnson  City  Hos- 
pital. 

At   Mead's   Hospital, 

Endicott,  N.  Y. 
do 

Fatal 

Full   recov- 
ery. 
do 

Hides  whitewashed  at 
shipping  point;  bales 
containing  hides 
whitewashed;    hides 

do 

do 

mercury  at  tannery. 

Unloading 

hides. 
Beamster 

Raw  -  skin 
trimmer. 

Bagging  hair 
from   raw 
material. 

2  cases;  occu- 
pation not 
given. 

Handling 

hides     in 

beam 

house . 

do 

do 

..  do... 

Gloversville... 

At  home 

do 

do 

do 

beam  house. 

.     .do 

Fatal 

Full  recov- 
ery. 

do 

do 

thalened;  solution  of 
weak  lime  liquor  for 
washing  hands. 

Antiseptic  solution  for 
washing  hands. 

Antianthrax  serum  on 
hand. 

Pennsylvania: 

Elkland 

..   ..do 

Various  tanneries.. 

27  cases;  oc- 
c  u  p  ation 
not  given. 

3  cases;  oc- 
c  u  p  ation 
not  given. 

do 

Immediate  care  of  all 

do 

Fatal 

wounds;  inquiry  as 
to  cause  of  illness  if 
absent. 

Of  the  70  cases  here  reported,  in  41,  or  more  than  half,  no  infor- 
mation as  to  occupation  is  given.  Of  the  remaining  29  victims,  the 
majority  (16)  were  beamsters  or  beam-house  workers,  while  only  6 
are  reported  to  have  been  working  on  dry  hides.  This  is  apparently 
a  reversal  of  the  ordinary  tannery  situation,  but  may  be  partially 
accounted  for  by  the  unusually  large  proportion  of  cases  in  which 
the  occupation  is  not  given.  Other  workers  affected  were  a  sweater, 
a  flesher,  a  raw-skin  trimmer,  one  engaged  in  bagging  hair  from  raw 
material,  and  a  repair  man.  Particularly  striking  is  the  case  of  the 
3-year  old  daughter  of  a  beam-house  employee,  to  whom  the  bacillus 
was  probably  carried  on  her  father's  clothing. 

Information  with  regard  to  sanitary  precautions,  given  by  the  19 
tanneries  and  leather  plants  which  reported  cases,  is  unusually  full. 
Prophylactic  measures  ranged  from  the  mere  furnishing  of  a  disin- 
fecting wash  for  the  men  to  daily  examination  of  all  employees  and 
even  discontinuance  of  the  use  of  the  more  dangerous  materials.  In 
addition  to  these  19  plants,  54  which  reported  no  cases  indicated 
that  they  took  precautions  as  follows : 

Instruction  to  employees  of  danger TO 

Immediate  treatment  of  wounds 21 

Furnishing  of  gloves 23 


46  BULLETIN    OF    THE    BUREAU    OF    LABOR    STATISTICS. 

Furnishing  of  respirators 2 

Employ   physician 1 

Employ  nurse 2 

Disinfect  hides  before  handling *  6 

During  the  summer  of  1916  the  National  Tanners'  Association 
took  up  the  question  of  more  thoroughly  disinfecting  their  plants 
to  guard  against  contagion  from  imported  hides.  Upon  applying 
to  the  Bureau  of  Animal  Industry  for  suggestions  as  to  how  to 
proceed  with  the  work,  the  tannery  owners  Were  advised  that  "  next 
to  fire,  bichloride  of  mercury  appears  to  be  the  most  efficient  agent 
in  the  sterilization  of  the  anthrax  spore."  The  bureau  therefore 
recommended  that  all  parts  of  the  premises  be  thoroughly  sprayed 
with  a  1  to  1,000  bichloride  of  mercury  solution,  then  scraped  and 
swept  (the  debris  being  carefully  burned),  next  scrubbed  with  the 
same  solution,  and  finally  given  another  spraying  with  it,  which 
should  be  allowed  to  dry  in.  Special  warning  was  issued  against 
continuous  wetting  of  the  hands  or  clothes  with  the  solution,  in 
order  to  avoid  mercurial  poisoning.2 

FATAL   CASES  REPORTED  IN   REGISTRATION  AREA   OF   THE  UNITED   STATES, 

1910  TO   1915. 

During  the  six  years  from  January  1,  1910,  to  December  31,  1915, 
no  fewer  than  132  deaths  from  anthrax  were  officially  reported  in 
the  United  States  registration  area,  which  covers  less  than  two-thirds 
of  the  total  population  of  the  country.3  Were  comparable  informa- 
tion available  for  the  entire  country  there  is  no  doubt  that  this  total 
would  be  considerably  augmented.  In  Texas,  for  instance,  during 
the  years  1912  to  1915  there  were  reported  to  the  State  board  of 
health  four  deaths,  none  of  which  appears  in  the  United  States  list 

1  Of  the  742  wool  dealers  or  wool  manufacturers  who  replied  to  the  circular  letters 
previously  mentioned,  the  replies  of  eight  indicated  that  precautions  were  taken  to  prevent 
anthrax.  Two  establishments  reported  cautioning  their  employees  to  give  immediate  treat- 
ment to  cuts  and  scratches,  besides  using  exhaust  fans  to  carry  off  the  dust ;  one  mill 
posted  notices  warning  employees  not  to  neglect  wounds  ;  four  concerns  used  exhaust  fans  ; 
and  one  manufacturer  of  wool  yarns  stated  that  he  disinfected  hides  before  handling. 

2  For  full  text  of  the  bureau's  communication,  see  Journal  of  the  American  Leather 
Chemists'  Association,  September,  1916,  pp.  510,  511. 

8  The  registration  area  in  1913  included  24  States — California,  Colorado,  Connecticut, 
Indiana,  Kentucky,  Maine,  Maryland,  Massachusetts,  Michigan,  Minnesota,  Mississippi, 
Montana,  New  Hampshire,  New  Jersey,  New  York,  North  Carolina  (cities  which  had 
1,000  or  more  inhabitants  in  1900),  Ohio,  Pennsylvania,  Rhode  Island,  Utah,  Vermont, 
Virginia,  Washington,  and  Wisconsin ;  and  41  additional  cities — Birmingham,  Mobile, 
and  Montgomery,  Ala. ;  Wilmington,  Del. ;  Jacksonville,  Key  West,  and  Pensacola,  Fla. ; 
Atlanta,  Augusta,  and  Savannah,  Ga.  ;  Aurora,  Belleville,  Chicago,  Decatur,  Evanston, 
Jacksonville,  Quincy,  and  Springfield,  111. ;  Atchison,  Coffeyville,  Fort  Scott,  Hutchinson, 
Independence,  Kansas  City,  Lawrence,  Leavenworth,  Parsons,  Pittsburg,  Topeka,  and 
Witchita,  Kans. ;  New  Orleans,  La. ;  Lincoln  and  Omaha,  Nebr. ;  Portland,  Oreg. ;  Charles- 
ton, S.  C. ;  Memphis  and  Nashville,  Tenn. ;  El  Paso,  Galveston,  and  San  Antonio,  Tex. ; 
and  Wheeling,  W.  Va.  The  population  covered  at  that  date  was  63,298,718,  or  65.1  per 
cent  of  the  total. 


ANTHBAX  AS  AN    OCCUPATIONAL   DISEASE.  47 

of  132,  presumably  because  they  occurred  in  outlying  districts  not  in- 
cluded in  the  registration  area.  Although  12  Kansas  cities  are  so 
included,  a  farmer  reported  to  the  State  board  of  health  as  having 
died  of  anthrax  in  1915  is  not  among  the  cases  known  to  the  Census 
Bureau.  Similarly  a  certificate  of  death  from  the  pulmonary  form  of 
the  disease  filed  with  the  Iowa  health  department  did  not  get  into  the 
Federal  statistics  because  Iowa  is  entirely  outside  the  registration 
area.  Since  the  close  of  1915,  also,  at  least  23  deaths  from  anthrax 
are  already  known  to  have  occurred.1  In  15  out  of  the  23  cases 
the  probable  source  of  the  disease  can  be  traced  through  the  occupa- 
tion or  other  facts  given.  Six  of  the  persons  worked  with  skins, 
hides,  or  hair,  two  handled  cargoes,  and  one  was  a  teamster  in  a 
seaport  town  where  infected  materials  are  known  to  have  been  re- 
ceived. Three  were  farmers,  one  a  "  sheepman,"  and  the  death 
certificate  of  one,  having  no  occupation,  stated  that  she  was  infected 
from  a  sick  cow.  A  Kansas  child  was  apparently  infected  by  a  cat 
which,  it  is  reported,  had  the  disease.  In  the  absence  of  specific 
information  as  to  occupation  or  surroundings,  the  cause  of  the  dis- 
ease can  not  be  traced  in  the  cases  of  five  "  laborers,"  a  "  foreman 
in  mill,"  a  "  housewife,"  and  a  boy  without  stated  occupation. 
This  information  is,  however,  scattering  and  incomplete,  and  while 
several  of  these  cases  are  discussed,  as  indicated,  in  the  sections 
of  this  report  dealing  with  their  respective  localities,  it  has  been 
thought  best  to  confine  this  section  of  the  study  to  those  fatalities 
officially  reported  to  the  United  States  Bureau  of  the  Census  for  the 
six  years  specified. 

Distribution  by  Industry,  Place  of  Death,   Etc. 

Of  the  132  persons  reported  as  dying  of  anthrax  during  this  six- 
year  period,  27  were  designated  on  the  official  death  certificates 
merely  as  "laborers,"  a  very  unsatisfactory  classification;  6  others 
were  designated  as  "  laborer,  clay,"  "  laborer,  paper  mill,"  "  laborer 
in  tannery,"  "  laborer,  morocco  works,"  •"  laborer,  freight  yard,"  and 
"  laborer,  longshore  " ;  12  as  housewives  or  housekeepers ;  9  as  farm- 
ers; 7  as  morocco  workers;  3  as  stevedores  or  longshoremen;  2  as 
liverymen;  2  as  barbers;  2  as  carpenters;  2  as  tailors;  2  as  young 
single  women  "  at  home,"  and  2  as  "  at  school."  The  following  desig- 
nations occur  once  each :  Handling  dry  hides,  paper-mill  hand,  tan- 
nery worker,  leather  worker,  stationary  engineer  in  morocco  works, 
mixing  hair,  hair-cloth  maker,  bristle  comber,  mill  hand  in  carpet 
factory,  freight  agent,  freight  handler,  weigher,  ranch  foreman, 
farm  hand,  veterinary  surgeon,  hairdresser,  merchant,  baker,  cake 
baker,  candy  packer,  cigar  maker,  retired  cigar  maker,  chair  maker, 
painter,  molder,  printer,  mechanic,  foreman,  electrical  supply  sales- 

1  See  footnote,  p  55. 
42806°— Bull.  205—17 4 


48  BULLETIN   OF    THE  BUREAU   OF    LABOR   STATISTICS. 

man,  domestic,  retired  pilot,  retired  farmer,  musician,  lawyer,  drug- 
gist, physician,  medical  student,  and  undertaker.  Eight  of  the  de- 
ceased were  reported  to  have  had  no  occupation,  and  in  10  cases  no 
information  on  this  point  was  given.  Other  data  on  the  certificates, 
however,  show  that  of  these  last  18  persons,  one  was  a  little  girl 
aged  6  and  five  were  infants  of  1  year  or  younger. 

In  a  few  cases  in  which  the  statement  of  occupation  given  on  the 
official  death  blank  did  not  agree  with  more  precise  information 
subsequently  obtained  from  other  sources  the  real  occupation  was 
without  significance  as  regards  causation  of  the  disease.  Thus  one 
woman  who  was  reported  as  a  cigar  maker  had  left  the  bench  at  the 
time  of  her  marriage,  30  years  before  she  died.  One  woman  who 
was  stated  to  have  no  occupation  was  acting  as  a  housekeeper  and 
nurse,  and  another  was  a  teacher.  A  man  reported  as  a  lawyer  had 
retired  and  had  no  active  occupation  except  caring  for  his  own 
country  home. 

On  the  other  hand,  in  other  cases  investigation  brought  out  occu- 
pational information  of  great  significance.  Thus,  the  man  reported 
as  a  weigher  was  employed  by  the  Federal  Government  in  the  cus- 
toms service  and  had  been  weighing  hides  and  skins  from  South 
America.  The  one  reported  as  freight  handler  worked  on  the 
wharves  and  was  really  a  longshoreman.  The  man  reported  as  a 
carpenter  was  employed  around  a  tannery.  The  man  reported  as  a 
molder  was  not  engaged  at  his  trade,  but  for  six  months  previous  to 
death  had  been  a  limer  and  general  helper  in  a  leather  factory.  The 
man  reported  as  an  undertaker  had  given  up  his  business  to  become 
an  employee  in  a  tannery  establishment,  where  he  checked  and 
received  imported  horsehides.  One  young  woman  who  was  reported 
as  staying  at  home  helped  on  her  father's  dairy  farm;  two  more, 
designated  as  housewives,  are  believed  to  have  contracted  the  disease 
from  a  sheep  and  from  a  cow,  respectively,  which  had  died  of  anthrax 
a  few  days  before ;  a  boy  whose  occupation  was  not  stated  did  chores 
about  home;  so  that  all  four  of  these  persons  may  appropriately  be 
classed  as  farmers.  Moreover,  of  the  30  reported  as  "laborers,"  it 
was  found  that  6  were  tannery  employees,  4  were  farm  or  ranch  hands, 
4  were  longshoremen,  1  was  a  freight  handler,  1  a  woolsorter,  1  a 
curled-hair  worker,  1  a  driver  who  had  been  unloading  hides  from 
a  vessel,  1  a  worker  in  a  morocco  factory,  and  1  a  paper-mill  employee. 

In  brief,  then,  although  in  about  50  cases  the  connection  between 
occupation  and  disease  is  obscure  or  nonexistent,  77,  or  a  majority  of 
the  persons  under  consideration,  were  in  occupations  where  the 
menace  of  anthrax  is  well  recognized.  Twenty-three  were  hide  and 
skin  workers  or  were  otherwise  employed  about  tanneries,  21  were 
farmers,  ranchmen,  or  women  living  on  farms,  13  were  transporta- 


ANTHRAX   AS  AN    OCCUPATIONAL   DISEASE.  49 

tion  workers,  6  worked  with  wool,  hair,  or  bristles,  2  were  rag  han- 
dlers in  paper  mills,  2  were  liverymen,  1  was  a  veterinarian,  and  9 
were  laborers,  probably  in  one  or  another  of  the  foregoing  branches 
of  industry. 

Tanning. — The  largest  single  occupational  group  among  the  132 
recorded  persons  who  succumbed  to  anthrax  in  the  United  States 
registration  area  during  the  six  years  1910  to  1915  is  composed  of 
tannery  employees,  of  whom  there  were  23. 

While  the  available  information  is  too  fragmentary  to  permit  a 
positive  statement,  there  is  strong  reason  for  believing  that  most 
of  these  23  workmen  were  engaged  not  in  the  late  but  in  the  earliest 
tannery  processes.  Thus  No.  105,  one  of  the  cases  given  in  detail 
on  pages  60  to  78,  was  unloading  at  the  factory  dry  South  American 
and  Chinese  hides.  Another  (No.  .80)  was  a  checker  and  receiver, 
and  dealt  with  Russian  horse  hides.  A  third  (No.  35)  had  been 
employed  for  two  years  as  an  assorter  of  hides.  Only  with  the  next 
man  (No.  58),  who  was  a  limer  and  general  helper,  do<  we  come 
to  an  actual  tanning  process,  and  even  he,  at  the  time  of  his  infection, 
had  been  helping  store  away  raw  sheepskins.  A  fifth  (No.  87)  was  a 
skin  washer,  while  a  sixth  (No.  50)  was  a  "lumper"  in  the  coloring 
room  of  a  morocco  and  calfskin  tannery.  This  last  operation,  which 
occurs  well  along  in  the  tanning  process,  is  the  latest  one  mentioned 
in  any  of  these  cases.  Special  note  should  be  made  of  the  circum- 
stances that  one  tannery  employee  (No.  1)  who  died  was  a  carpenter 
and  that  another  (No.  54)  was  a  stationary  engineer.1  The  remaining 
15  tannery  employees  (Nos.  2,  3,  5, 10,  20,  41,  49,  69,  74,  93,  94,  97, 103, 
126  and  128)  are  described  merely  as  "  laborer  in  tannery,"  "  morocco 
worker,"  or  by  some  similar  indefinite  term;  but,  judging  from  the 
experience  in  the  groups  of  local  cases  previously  examined,2  it 
is  reasonable  to  believe  that  many  of  these  were  porters,  warehouse- 
men, and  the  like,  who  handled  the  hides  in  the  earliest  stages,  be- 
fore actual  tanning  had  begun.  Fourteen  of  the  total  number  here 
grouped  as  working  at  "tanning"  are  described  as  employed  in 
tanneries  or  leather  factories  (i.  e.,  establishments  curing  cow,  horse, 
and  similar  large  hides),  while  nine  are  described  as  employed  in 
morocco  works,  where  goat,  sheep,  and  other  light  skins  are  tanned. 

Farming  and  Ranching. — Twenty-one  of  the  132  fatal  cases  of 
anthrax  under  discussion  occurred  among  farmers,  ranchmen,  or 
others  engaged  in  similar  pursuits.  In  half  of  the  cases  (Nos.  8,  18, 
22,  48,  70,  71,  75,  104,  124,  and  132)  the  source  of  infection  remains 
unknown.  One  young  woman  (No.  120)  in  this  group,  however, 
assisted  her  father  on  his  dairy  farm.     A  boy  of  16  (No.  65)  helped 

1  For  the  case  of  a  steam  fitter  who  contracted  the  disease  in  a  tannery,  see  p.  36. 

2  See  pp.  32  and  43. 


50  BULLETIN"   OF    THE   BUEEAU    OF   LABOE   STATISTICS. 

care  for  his  father's  cow  and  horse.  A  California  farm  laborer 
(No.  99)  at  the  time  of  his  attack  handled  cattle  and  cattle  hides  of 
local  origin.  A  California  woman  (No.  33)  who  lived  on  a  farm  16 
miles  from  town  is  believed  to  have  been  infected  indirectly  from  a 
dead  sheep.  In  the  case  of  another  California  housewife  (No.  84), 
evidently  the  wife  of  a  farmer,  and  in  that  of  a  Vermont  farm  hand 
(No.  24),  the  contagion  was  traced  directly  to  sick  cows,  one  of 
which  died.  Three  men,  in  Louisiana,  Kansas,  and  Pennsylvania, 
respectively  (Nos.  26,  15,  and  12),  were  infected  by  skinning  cattle 
which  had  died  of  the  disease.  A  Wisconsin  farmer  (No.  83)  opened 
a  cow  to  ascertain  the  cause  of  its  death,  and  even  dissected  the 
characteristic  black  spots  he  found  in  its  abdomen.  Particularly 
striking  is  the  story  of  a  New  York  farmer  (No.  78)  who,  according 
to  the  physician,  "  was  in  the  habit  of  buying  up  old  and  poorly 
nourished  cattle,  butchering  them,  and  selling  them  where  he  could." 
While  awaiting  trial  on  charges  of  selling  tuberculous  meat  this  man 
apparently  slaughtered  for  sale  an  animal  suffering  from  anthrax, 
and  died  as  a  result.  The  possibility  of  acquiring  the  disease  by 
eating  the  meat  of  anthrax-infected  animals  seems  to  be  well  recog- 
nized.1 

Longshore  Woek. — At  least  9  of  the  13  transportation  workers  re- 
ported as  dying  from  anthrax  were  longshoremen  at  the  ports  of 
Boston  (Nos.  43,  76,  108,  110,  and  127),  Philadelphia  (Nos.  56,  82, 
and  89),  and  New  York  (No.  131).  Probably  the  Boston  "freight 
handler  "  (No.  4)  and  the  New  York  "  laborer  and  driver"  (No.  116), 
elsewhere  discussed,  also  belong  in  this  group.  Six  of  the  nine  men 
unloaded  hides,  specified  in  one  instance  as  coming  from  South 
America  and  from  "  America  " ;  one  unloaded  hides  and  wool ;  one 
hair  from  China ;  and  the  nature  and  source  of  the  materials  handled 
by  the  other  are  not  stated.  The  death-bearing  hides  in  two  cases 
are  known  to  have  been  dry.  These  hides  arrive  sometimes  in  large 
burlap- wrapped  bales,  sometimes  loose.  In  either  case  the  labor  of 
fastening  tackle  upon  them,  hauling  them  from  the  hold,  and  lugging 
them  onto  the  pier  offers  manifold  opportunities  for  abrasions  and 
scratches  of  the  skin,  which  readily  become  infected  by  the  spore- 
laden  hides  or  the  dust  therefrom.  (See  cut  facing  this  page.)  Five 
of  the  lesions  in  this  group  appeared  on  the  face,  three  on  the 
neck,  and  the  position  of  one  is  not  given.  In  one  of  these  cases 
application  for  indemnity  was  made  under  the  Massachusetts  work- 

1  That  the  business  methods  of  this  man  are  not  unprecedented  is  shown  by  the  state- 
ment of  Ravenal  that  he  had  "  known  an  animal  in  the  last  stages  of  anthrax  to  be 
slaughtered  and  dressed  for  market  by  a  thrifty  farmer  who  saw  his  cow  about  to  die 
and  wished  to  avoid  loss.  Examination  of  the  blood  of  this  animal  proved  it  to  be 
swarming  with  anthrax."  (Article  on  Anthrax  in  Modern  Medicine,  1907,  Vol.  Ill, 
pp.   42-51.) 


ANTHRAX   AS  AN    OCCUPATIONAL   DISEASE.  51 

men's  compensation  law,  but  was  denied  on  the  ground  that  the  infec- 
tion occurred  while  the  workman  was  in  the  employ  of  a  steamship 
line  other  than  the  one  named  in  the  application.1 
"  Customs  Weighing. — A  case  (No.  Ill)  which  brought  into 
striking  relief  the  inadequacies  of  the  Federal  Employees'  Compensa- 
tion Act  of  May  30,  1908,  was  that  of  a  Government  weigher  in  the 
customs  service.  This  man's  duties  included  tearing  open  the  bales 
of  hides,  examining  their  contents,  and  weighing  them.  (See  cut 
facing  this  page.)  Just  before  falling  ill  he  had  worked  on  hides  and 
skins  from  South  America.  His  widow,  though  left  with  three 
small  children,  was  unable  to  secure  indemnity  from  the  United 
States  Government  because  customs  weighers  were  not  covered  by 
the  act. 

Truck  Driving. — Another  transportation  worker  (No.  116)  whose 
attack  of  anthrax  proved  fatal  is  reported  as  laborer  and  driver; 
he  had,  however,  for  the  week  preceding  illness,  been  "  unloading 
hides  from  a  vessel,"  so  that,  as  previously  stated,  he  probably  be- 
longs among  the  longshoremen.  In  his  case  the  anthrax  papule 
appeared  on  the  chest. 

Freight  Handling. — The  two  remaining  fatal  cases  occurring  in 
transportation  work  were  those  of  freight  men — one  designated  as 
an  agent  and  the  other  as  a  handler  (Nos.  61  and  4,  respectively), 
The  latter,  however,  was  most  likely  a  Boston  longshoreman.  His 
infection  was  on  the  right  arm.  The  freight  agent  worked  in  a 
small  Pennsylvania  town,  but  nevertheless  contracted  anthrax  from 
handling  foreign  hides. 

Hair  Working  and  Weaving. — Four  of  those  who  died  of  anthrax 
were  engaged  in  different  processes  of  hair  working  and  hair  weav- 
ing. One  (No.  55)  had  been  employed  for  only  eight  months  as 
a  laborer  in  a  curled-hair  factory  using  large  quantities  of  imported 
material.  Another  (No.  17)  mixed  animal  hair  in  machines,  pre- 
paratory to  spinning;  a  third  (No.  63)  was  a  haircloth  maker  and 
was  taken  fatally  ill  after  working  over  a  bale  of  Siberian  hair; 
and  the  fourth  of  this  group  (No.  106)  was  employed  in  a  carpet 
factory  where  the  coarser  grades  of  hair  are  woven. 

Woolsorttng. — One  man  (No.  7)  who  succumbed  to  anthrax  came 
in  contact  with  raw  American  sheep  wool,  and  according  to  the 
physician's  statement,  was  probably  a  woolsorter.  In  this  work  the 
bales  of  wool  are  first  placed  on  racks  over  steam  pipes,  which  heat 
the  wool  and  soften  the  natural  grease  it  contains  so  that  the  fleeces 
can  easily  be  opened  out.  The  workbench  has  a  top  of  wire  screen, 
through  which  the  dirt  and  impurities  drop,  and  within  easy  reach 

1  See  pp.  89  and  91. 


52  BULLETIN"   OF    THE   BUREAU    OF   LABOR   STATISTICS. 

are  a  number  of  baskets  or  crates,  one  for  each  grade  of  wool  which 
is  to  be  separated.  (See  cut  facing  p.  53.)  Usually  the  only  tool  is 
a  pair  of  woolsorter's  scissors,  for  clipping  off  tar  and  other  matter 
which  may  be  found  adhering  to  the  fleece.  The  whole  process  is 
very  simple,  but  gives  rise  to  large  quantities  of  dust,  the  fine  parti- 
cles of  which  form  convenient  vehicles  for  the  anthrax  spores. 

Bristle  Combing. — One  fatal  case  (No.  38)  was  that  of  a  man 
employed  as  a  bristle  comber  and  hair  dyer.  The  materials  he 
worked  with  came  from  Siberia. 

Paper  Making. — Two  of  those  who  died  with  anthrax  symptoms 
handled  rags  in  paper  mills.  One  (No.  11)  unloaded  baled  rags 
from  cars,  and  trucked  them  into  the  storage  sheds  and  to  the  cutting 
rooms,  where  the  rag  cutters  would  open  the  bales  and  feed  the  rags 
into  the  cutting  machines.  The  other  (No.  14)  was  engaged  as  a 
bleach  boy  in  the  rag  room.  Both  workers  handled  large  quantities 
of  imported  rags  from  such  countries  as  England,  Ireland,  Germany, 
France,  Italy,  and  Spain. 

Liverymen. — Two  of  the  deaths  (Nos.  67  and  95)  were  among 
liverymen.  The  former  had  a  pustule  on  the  lower  lip,  which  at  his 
request  was  opened  with  a  penknife  by  a  relative.  The  penknife, 
however,  had  previously  been  used  by  the  patient  to  incise  what  he 
considered  an  "  abscess  "  on  one  of  his  horses,  so  that  the  physician 
is  not  certain  whether  the  case  was  anthrax  from  the  start  or  whether 
inoculation  occurred  through  the  knife.  The  knife  had  disappeared 
and  could  not  be  examined  for  anthrax  bacilli. 

Veterinary  Surgery. — One  of  the  most  interesting  cases  of  fatal 
anthrax  (No.  47),  from  the  clinical  point  of  view,  which  was  disclosed 
in  this  study  was  that  of  a  veterinary  surgeon.  Some  12  days  be- 
fore becoming  alarmed  over  his  condition  he  had  performed  an 
autopsy  on  some  cows,  in  the  course  of  which  he  scratched  his  fore- 
finger. He  cauterized  the  scratch  and  nothing  developed  there,  but 
he  probably  scratched  himself  at  the  same  time  on  the  other  wrist,  for 
a  week  later  there  developed  in  that  location  the  pustule  which 
caused  his  death. 

Barbers  and  Hairdressers. — Two  of  the  132  persons  dying  of 
anthrax  (Nos.  21  and  77)  were  barbers  and  one  (No.  40)  was  a  hair- 
dresser. All  were  men.  In  none  of  these  cases  were  details  ob- 
tainable, but  a  possible  source  of  infection  is  indicated  by  the  evidence 
presented  on  page  23  regarding  infection  through  shaving  brushes. 
Early  in  March,  1916,  also,  the  New  York  city  bureau  of  public 
health  education  received  a  communication  from  Dr.  A.  K.  Chalmers, 
health  officer  of  Glasgow,  Scotland,  stating  that  two  shipments  of 
London-made  shaving  brushes  had  been  received  in  Glasgow  and 
that  each  brush  had  been  found  to  contain  anthrax  germs.     The  New 


ANTHRAX   AS  AN   OCCUPATIONAL  DISEASE.  53 

York  health  department  thereupon  announced  that  all  future  im- 
portations of  shaving  brushes  would  be  thoroughly  examined  for  the 
presence  of  the  germs. 

"  Laborers." — In  nine  fatal  cases  the  occupation  of  the  deceased 
workman  is  obscured  under  the  vague  designation  "  laborer."  Two 
of  these  deaths  (Nos.  101  and  102)  occurred  within  two  and  one-half 
weeks  of  each  other  in  Pennsylvania  tannery  towns,  a  third  (No.  29) 
occurred  in  a  Massachusetts  city  with  large  shoe  works  as  well  as  tan- 
neries; and  a  fourth  (No.  34)  took  place  in  Philadelphia,  where  in 
both  hair  works  and  tanneries  the  risk  of  occupational  anthrax  is 
great.  In  these  cases  what  the  victims  worked  at  can  be  surmised 
with  approximate  accuracy,  but  in  the  remaining  five  cases  (Nos.  25, 
31,  42,  91,  and  109)  there  is  no  clue  whatever.  From  the  standpoint 
both  of  accurate  morbidity  statistics  and  of  efficient  prevention  of 
occupational  disease,  such  loose  reporting  should  be  discouraged. 

Musician. — One  man  (No.  30)  was  a  traveling  musician,  and  at 
the  time  of  his  death  is  believed  to  have  been  with  a  circus.  As  he 
was  fond  of  horses  it  is  suggested  that  he  may  have  contracted  the 
disease  from  one  of  the  circus  animals. 

Housekeeping. — Fourteen  of  the  fatalities  reported  as  from 
anthrax  occurred  among  women  who  were  acting  as  housewives  (Nos. 
6,  9,  39,  53,  57,  68,  85,  96,  and  119),  housekeepers  (Nos.  28  and  52), 
housekeepers  and  nurses  (No.  66),  domestics  (No.  62),  or  (No.  92) 
simply  living  "  at  home  "  with  no  definite  occupation.  In  no  case  is 
the  source  of  infection  indicated. 

Infants. — Five  of  the  reported  victims  of  anthrax  were  infants 
1  year  old  or  less.  In  three  of  these  cases  (Nos.  16,  73,  and  88)  the 
mode  of  infection  is  unknown.  A  girl  baby  of  4  months  (No.  64) 
was  struck  on  the  mouth  with  a  fly  swatter  in  the  hands  of  an  older 
child  who  was  tending  her,  breaking  the  skin  and  perhaps  intro- 
ducing the  fatal  bacillus  or  spore  from  a  fly  which  had  previously 
been  killed  with  the  implement.  The  physician's  history  in  the 
remaining  case  (No.  98)  is  most  convincing.  This  little  boy,  aged  1, 
lived  on  a  farm.  He  was  scratched  on  the  leg  by  the  teeth  of  a  pet 
dog  with  which  he  was  playing.  The  dog  had  been  feeding  on  the 
unburied  carcass  of  a  calf  that  had  died  of  anthrax.  A  pure  culture 
of  anthrax  was  taken  from  the  child's  leg. 

No  Occupation. — Of  the  eight  persons  who,  according  to  the 
official  death  blanks,  had  no  occupation,  six  are  elsewhere  considered. 
The  seventh  (No.  32)  was  a  man  of  38,  and  the  last  (No.  79)  a  girl 
of  14.  In  none  of  these  cases  could  additional  information  of 
importance  be  secured. 

Occupation  Not  Stated. — In  seven  cases  the  occupation  was  not 
stated  on  the  official  death  certificates  and  could  not  be  determined 


54  BULLETIN"   OP   THE   BUREAU   OF    LABOR   STATISTICS. 

from  other  sources.  Three  of  these  (Nos.  81,  86,  and  117)  were  men, 
aged  52,  54,  and  52  years,  respectively.  One  (No.  107)  was  a  girl 
6  years  old,  the  discharges  from  whose  nose  contained  a  bacillus 
"  having  all  the  characteristics  of  the  bacillus  anthracis."  The  other 
three  were  women.  One  (No.  113)  was  on  a  visit  to  New  York 
Avhen  she  pricked  a  pimple  oh  her  lip  with  a  needle..  The  records 
for  the  remaining  two  (Xos.  13  and  37)  are  brief  and  afford  no  clue 
to  the  cause  of  the  disease. 

Miscellaneous  Cases,  Occupation  Not  Significant. — There  re- 
main 23  recorded  victims  of  fatal  anthrax  attacks  whose  occupations, 
as  given  by  the  official  death  certificates,  checked  up  from  other 
sources,  bear  no  visible  relation  to  the  disease  and  are  too  scattered 
to  be  considered  in  groups.  The  cause  of  infection  in  a  few  of  these 
cases  has  been  roughly  surmised.  A  tailor  (No.  90)  and  a  young 
woman  school-teacher  (No.  44)  are  believed  by  their  physicians  to 
have  been  infected  by  insect  bites.  Two  girls,  one  (No.  115)  a  post- 
office  clerk,  and  the  other  (No.  121)  a  candy  packer,  are  supposed  by 
some  physicians  to  have  contracted  the  disease  from  fur  neck  pieces, 
but  this  theory  is  opposed  by  medical  men  of  high  standing.  In  the 
19  cases  still  remaining  no  explanation  for  the  onset  of  the  disease 
has  been  offered. 

Place  and  Date  of  Death. — Just  half  of  the  total  number  of 
deaths,  or  66  in  all,  occurred  in  the  three  States  of  Pennsylvania, 
New  York,  and  Massachusetts.  The  distribution  by  States  in  detail 
was — Pennsylvania,  31 ;  New  York,  23 ;  Massachusetts,  12 ;  California 
and  Ohio,  9  each;  Connecticut,  8;  Delaware,  7;  Louisiana,  Minne- 
sota, and  New  Jersey,  4  each;  Indiana  and  Kentucky,  3  each;  Colo- 
rado, Missouri,  Wisconsin,  Virginia,  and  Maine,  2  each;  Washing- 
ton, Montana,  Utah,  Nebraska,  Maryland,  and  Vermont,  1  each. 

Grouped  by  years,  the  deaths  took  place  as  follows :  Nineteen  hun- 
dred and  ten,  22;  1911,  14;  1912,  17;  1913,  25;  1914,  19;  1915,  35; 
total,  132. 

Considered  by  months,  there  seemed  to  be  a  period  of  high  fre- 
quency during  March,  April,  and  May,  followed  by  a  lull  in  the 
summer  and  early  autumn,  and  another  high-frequency  period,  even 
higher  than  the  first,  toward  the  close  of  the  year.  In  half  of  the 
six:  years,  the  largest  number  of  deaths  in  any  single  month  occurred 
in  March  or  May ;  in  two  years  it  occurred  in  November  and  Decem- 
ber; and  in  the  remaining  year  the  three  months  which  had  the 
same  high  number  of  fatalities  were  March,  April,  and  December. 
Whether  this  apparently  regular  fluctuation  is  accidental  only  or 
indicates  a  real  variation  in  the  risk  of  infection  can  not  yet  be 
decided. 

Nativity,  Age,  Sex,  and  Conjugal  Condition. — Seventy -nine,  or 
not  quite  three-fifths,  of  the  persons  who  died  of  anthrax  in  these 


ANTHRAX   AS  AN    OCCUPATIONAL   DISEASE. 


55 


six  years  were  born  in  America,  and  51  of  them  died  in  the  States 
where  they  were  born.  There  were  also  8  Russians,  7  Poles,  6 
Irishmen,  5  Germans,  5  Austrians,  5  Italians,  5  Canadians,  3  Eng- 
lishmen, 3  Scotchmen,  1  Frenchman,  1  Greek,  1  Bohemian,  1  Hun- 
garian, 1  Swede,  and  1  native  of  the  Azores  Islands.  Their  ages 
ranged  from  3  months  to  81  years,  but  more  died  between  the  ages 
of  31  and  40  and  51  and  60  than  in  any  other  age  decade.  One 
hundred  three  were  males,  and  29  were  females.  Seventy-nine  were 
married,  46  single,  6  widowed,  and  1  was  divorced.® 

STATISTICAL  SUMMARY. 

The  following  table  presents  in  chronological  order  the  132  deaths 
recorded  as  from  anthrax  in  the  United  States  during  the  six  years 
1910  to  1915,  inclusive,  showing  the  place  of  death,  birthplace,  con- 
jugal condition,  date  of  death,  age,  occupation,  and  recorded  cause 
of  death : 

Table  6.— DEATHS  FROM  ANTHRAX  REPORTED  IN  THE  UNITED  STATES,  1910  TO  1915. 
[Data  drawn  from  official  certificates  of  death.] 


Case 
No. 

Place  of  death. 

Birth- 
place. 

Con- 
jugal 
condi- 
tion. 

Date  of 
death. 

Age. 

Occupation. 

Cause  of  death. 

1 

Elmira,  N.  Y 

Pa 

Germany 
Greece . . 
Ireland  . 
England 
Ohio.... 

Italy.... 
Ind 

Pa 

Del 

M. 

M. 
S. 
S. 
M. 
M. 

M. 
M. 

S. 
S. 

1910 

Jan.      2 

Jan.    10 
Jan.    11 
Jan.    29 
Feb.  15 
Mar.    8 

Mar.  28 
Apr.     1 

Apr.  22 
June    4 

39 

50 
24 
34 
32 
68 

51 
52 

49 
17 

Carpenter  ' 

Morocco  worker . . . 

Anthrax    (external); 

tetanus. 
Anthrax. 

2 
3 

Wilmington,  Del 

San  Francisco,  Cal 

4 

do3 

5 

Philadelphia,  Pa 

do2 

Do. 

6 

Housewife 

Laborer  4 

Law  and  farming. . 

Cigar  maker  6 

Morocco  worker . . . 

Septicemia;  anthrax 

and  Bright's. 
Anthrax. 

7 
8 

Williamsport,  Pa 

9 

ure. 

Anthrax. 

10 

Wilmington,  Del 

Do. 

Special  inquiry  disclosed  that  the  actual  occupation  just  prior  to  death  was  as — 

1  Carpenter  at  tannery. 

2  Laborer  in  tannery. 

3  Freight  handler. 

*  Worker  with  raw  sheep  wool;  probably  a  woolsorter. 
6  Housewife. 

a  Between  the  beginning  of  1916  and  the  final  proof  reading  of  this  report  (Dec.  24, 
1916),  18  additional  cases  of  death  from  anthrax  had  been  discovered  by  clerks  in  the 
Census  Office  in  the  course  of  their  routine  compilation  of  death  certificates  for  that 
year.  The  victims  were,  in  chronological  order :  "  Sheepman,"  Columbia  County,  Wash. ; 
Occupation  not  given,  Hodgensville,  Ky.,  anthrax  infection  from  sick  cow ;  Wool 
washer,  Johnstown,  N.  Y. ;  Tanner,  Chicago ;  Boy,  occupation  not  given,  New  York 
city  ;  "  Laborer,"  Boston  ;  Foreman  in  mill,  Philadelphia  ;  "  Laborer,"  Philadelphia  ; 
Farmer,  Goldsboro,  N.  C.  ;  Teamster,  Boston  ;  "  Laborer,"  Philadelphia ;  Longshoreman, 
Boston  ;  "  Laborer,"  St.  James,  Mo.  ;  Farmer,  Glendale  Springs,  N.  C. ;  Currier,  Boston  ; 
"  Laborer,"  Philadelphia  ;  Farmer,  Beaumont,  Tex.  ;  Housewife,  San  Antonio,  Tex.  In 
an  account  of  the  outbreak  in  Massachusetts,  1916,  in  the  United  States  Public  Health 
Reports  for  Dec.  15,  1916,  the  two  additional  fatalities  were  recorded  of  a  tannery 
worker  (beam  house),  Winchester,  and  a  dock  laborer,  Chelsea.  Two  other  cases  of 
death  traced  through  the  United  States  Public  Health  Reports  and  through  newspaper 
accounts,  respectively,  were  that  of  a  curled-hair  worker  in  Detroit,  Mich.,  on  Aug.  12, 
1916,  after  an  illness  of  24  hours,  and  of  a  tannery  worker  in  Arroyo,  Pa.,  on  Nov.  19, 
1916.  There  was  likewise  on  record  the  fatal  case  of  a  Kansas  child  who  was  appar- 
ently infected  by  a  cat.  Several  of  these  cases  have  already  been  discussed  in  the  sec- 
tions dealing  with  the  experience  of  particular  States  or  hospitals. 


56 


BULLETIN   OF    THE   BUREAU    OF    LABOR   STATISTICS. 


Table  6.— DEATHS  FROM  ANTHRAX  REPORTED  IN  THE  UNITED  STATES,  1910  TO  1915— 

Continued. 


Place  of  death. 


Birth- 
place. 


Con- 
jugal 
condi- 
tion. 


Date  of 
death. 


Age. 


Occupation. 


Cause  of  death. 


Greensburg,  Pa. 
Howe,  Pa 


Philadelphia,  Pa. 
Holyoke,  Mass 


La  Junta,  Colo . 
Fairport,  Ohio . 


Baltimore,  Md. 


Pomona,  Cal.. 
Newcastle,  Pa. 


Elmira,  N.  Y. 


Fresno,  Cal. 


Kittery,  Me 

Canastota,  N.  Y 


Waterford,  Vt. 
Harrison,  Ind. 


New  Orleans ,  La 

Windham  Co.,  Conn. . . 
New  Britain,  Conn 


Lynn,  Mass 

Cleveland,  Ohio. 
Monterey,  Cal . . . 
Dubois,  Pa 


Bakersfield;  Cal . . 
Philadelphia,  Pa. 

Wilmington,  Del. 

New  Orleans,  La. 


Logan  County,  Ky 


Philadelphia,  Pa 

Mesopotamia,  Ohio 


Philadelphia,  Pa. 
Wilmington,  Del. 


Austria . 
Canada . 


England 
Mass 

Scotland 
Ohio.... 

Germany 


111. 
Pa. 


N.Y.... 
Germany 
Me... 
N.Y. 


Vt.. 
Ind. 


La 

Conn... 
Ireland. 


..do.. 
Bohemia 
Cal 

Hungary 


France. 
Austria 


Pa. 
La. 

Ky. 


Pa... 
Ohio. 


Md 

Russian 
Poland 


W. 
S. 


M. 


M. 

W. 


M. 


M. 

M. 


M. 

S. 

M. 
S. 
M. 


M. 


1910 

June  29 

July   19 


Aug.     8 
Aug.  20 

Oct.     2 
Oct.    13 

Dec.     2 


Dec.     8 
Dee.  19 


Dec.  22 


Dec.  28 


Dec.  29 


1911 

Jan.    27 


Feb.  28 
Apr.  28 

Apr.  28 
May  7 
May   16 


May  30 

June  21 

July  10 

July  28 

Oct.    16 
Nov.    7 

Nov.  20 

Dec.  27 


1912 

Feb.     3 


Feb.     6 
Feb.  13 


Mar.     2 
Mar.     6 


34 


4 

mos 

62 


Laborer, 

mill. 
do... 


paper 


60     Not  reported. 
15     Paper  mill ' . . 


Ranch  foreman... 
None 


Mixing  hair  (ani- 
mal) in  ma- 
chines, prepar- 
ing for  spinning. 

Farmer  (retired) . . 

Baker 


Mechanic 2 . 


Barber. 


Farmer. 


Cigar  maker  (re- 
tired). 


Laborer 3. 
do... 


Farmer 

Tailor* 

Housekeeper . 


Laborer . . 
Musician  ■ 
Laborer.. 


None. 


Housewife . 
Laborer . . . 


Assorter  of  hides, 
morocco  works... 

Salesman,  electric 
supplies. 


Not  reported. 


Bristle  comber  s. 
Housewife 


Hairdresser 

Morocco  worker 7 . 


Anthrax;  septic  in- 
toxication. 

Anthrax;  skinning 
cow  dead  with  the 
disease. 

Anthrax;  bronchitis. 

General  sepsis;  an- 
thrax. 

Anthrax. 

Cramps— disease  of 
bowel;  anthrax. 

Toxemia;   anthrax'. 


Anthrax;  senility. 

Anthrax;  exhaus- 
tion following  dis- 
ease. 

Anthrax,  external, 
and  general  tox- 
emia. 

Anthrax,  followed 
by  septic  abscesses 
and  pyemia. 

Septicemia  with  ma- 
lignant pustule. 

Anemia;  malignant 
pustule,  right 
cheek. 

Anthrax. 

Anthrax;  septice- 
mia. 

Anthrax. 
Do. 

Anthrax  (malignant 
pustule);  septice- 
mia. 

Anthrax;  pulmonary 
tuberculosis. 

Malignant  pustule; 
edema  of  glottis. 

Anthrax;  acute  ure- 
mia. 

Anthrax;  anthrax 
edema. 

Anthrax. 

Anthrax;  due  to  ba- 
cillus anthracis. 

Anthrax. 

Anthrax  (carbuncle) ; 
malignant  pustule. 


Malignant  pustule; 

heart  paralysis. 
Anthrax. 
Malignant    pustule 

on  right  side  of  face; 

abscess  of  right  kid- 

nev. 
Anthrax. 
Do. 


Special  inquiry  disclosed  that  the  actual  occupation  just  prior  to  death  was  as — 
i  Bleach  boy  in  rag  room  of  paper  mill. 
a  Handler  of  hides  in  leather  company. 
8  Farm  laborer. 
« Tailor  and  presser. 
6  Musician  traveling  with  circus. 
6  Bristle  comber  and  hair  dyer. 
'  Morocco  worker;  probably  in  the  beam  house. 


ANTHRAX   AS   AN    OCCUPATIONAL  DISEASE. 


57 


TABLE 6. —DEATHS  FROM!  ANTHRAX  REPORTED  IN  THE  UNITED  STATES,  1910  TO  1915— 

Continued. 


Place  of  death. 


Birth- 
place. 


Con- 
jugal 
condi- 
tion. 


Date  of 
death. 


Occupation. 


Cause  of  death. 


Toledo,  Ohio. 


Boston,  Mass 

New  York,  N.  Y. 
Cincinnati,  Ohio  . 


Allegheny  County,  Pa. 
Orange,  N.J 


48  i  Richland,  Mo 

49  ■  Philadelphia,  Pa. 

50  j  Peabody,  Mass. .. 

51  St.  Paul,  Minn... 


Graves  County,  Ky. . 
Ballard  County,  Ky. 


54  Wilmington,  Del. 

55  |  Philadelphia,  Pa. 


56    do 

57  !  Snohomish  County, 

Wash. 

58  '  Gloversville,  N.  Y 


59  Brooklyn,  N.  Y. 

60  :  Gardner,  Mass. . . 

61  j  Cascade,  Pa 

62  Racine,  Wis 


63  !  Philadelphia,  Pa. 

64  Wilkes'-Barre,  Pa. 


Hennepin  County,Minn 
North  Attleboro,  Mass. 
Windsor  Locks,  Conn. . 


Brighton,  Pa 

Wilmington,  Del. 
Lincoln,  Mo 


Gates,  N.  Y. 


Elyria,  Ohio. 
Unity,  Pa... 


Ohio. 


Mass... 


N.  Y... 
Ohio... 


Ireland 
N.  J.... 


Ind 

Russia.. 
...do.... 
Minn 


Ky 

Term.... 


Md 

Poland. . 


Del. 
Wis. 


Ireland. . 
Italy.... 


Pa 

Russia. 


Poland. 


Minn.... 
Canada  . 
Conn 


Pa 

Ireland  . 
Mo 


N.  Y.... 

Ohio.... 

Pa 


M. 
M. 

M. 

M. 

M. 
M. 

M. 
M. 
M. 


M. 

S. 

S. 

w. 

M. 

M. 

S. 

s. 


1913 

Mar.     7 


Mar.     9 


June    2 
July   23 


Aug.     6 
Sept.  13 


Oct.  14 
Nov.  14 
Nov.  18 
Nov.  20 

Dec.  4 
Dec.  23 

1913 

Jan.    19 

Jan.    23 

Feb.  13 
Feb.  15 

Mar.     1 

Apr.     6 

Apr.  12 
May  2 
May     5 


May     9       25 
May  28  [    4 
mos, 


July  17 
July  20 
Aug.    5 

Aug.  13 
Aug.  23 
Sept.    8 

Sept.  29 


Oct.      7 
Oct.    22 


Laborer. 


Laborer — lonj 

shore. i 
Not  reported  2... 
Retired  pilot 


Foreman 

Veterinary  surgeon 


Farmer. . . 
Laborer  !. 
Morocco  * . 
At  school. 


Housekeeper. 
Housewife 


Morocco,    station- 
ary engineer. 
Laborer  5 


do.s... 

Housewife. 


Molder  i. . 
Druggist. 


Chair  maker 

Freight  agent 8. 
Domestic 


Haircloth  maker. 


Laborer 9 . . . 

None  i° 

Liveryman . 


Housewife 

Morocco  worker. 
Farmer 


Not  reported ' 

Physician 

None 


Special  inquiry  disclosed  that  the  actual  occupation  just  prior  to  death  was  as — 
i  Longshoreman  handling  hides. 

2  School-teacher. 

3  Laborer  in  tannery. 

<  Lumper  in  coloring  room  of  morocco  and  calfskin  factory. 

s  Laborer  in  curled-hair  factory. 

•  Longshoreman  loading  hides  and  wool. 

7  Limer  and  general  helper  in  leather-dressing  establishment. 

8  Freight  agent  handling  foreign  hides. 

9  General  helper  on  small-fruit  farm, 
i"  Housekeeper  and  nurse. 

11  Chore-boy  around  home. 


Exhaustion  from 
chronic  cystitis, 
blood  poisoning; 
anthrax — malig- 
nant pustules  on 
leg  and  hand. 

Septicemia;  anthrax. 

Malignant  pustule. 

Anthrax  or  carbun- 
cle; septicemia 
and  asthenia. 

Anthrax. 

Inoculation  by  an- 
thrax bacilli,  caus- 
ing general  sys- 
temic poisoning. 

Anthrax. 
Do. 
Do. 

Malignant  pustule; 
blood  poisoning. 

Anthrax. 
Do. 


Malignant  pustule. 

Anthrax     carbuncle 

of  neck. 
Anthrax. 
Anthrax     of     right 

hand. 
Anthrax;    edema    of 

glottis. 
Anthrax  of  the  neck; 

fatty  degeneration 

of  heart. 
Anthrax  infection  of 

face. 
Anthrax. 

Malignant  pustule  on 
face,  also  internal 
in  mouth;  edema 
of  glottis. 

Anthrax. 

Malignant  pustule. 

Anthrax. 

Malignant  pustule. 

Malignant  pustule ; 
septicemia. 

Anthrax. 
Do. 

Anthrax;  metastatic 
pneumonia. 

Splenic  fever;  malig- 
n  a  n  t  facial  an- 
thrax. 

Anthrax ;  chronic 
nephritis. 

Cholera  infantum 
and  anthrax. 


58 


BULLETIN   OF    THE   BUREAU    OF    LABOR   STATISTICS. 


Table  6.— DEATHS  FROM  ANTHRAX  REPORTED  IN  THE  UNITED  STATES,  1910  TO  1915— 

Continued. 


Place  of  death. 


Birth- 
place. 


Con- 
jugal 
condi- 
tion. 


Date  of 
death. 


Occupation. 


Cause  of  death. 


Lycoming  County, Pa. 
Hanford,  Cal 


Boston,  Mass. .. 
Winchester,  Ya . 


Union,  N.  Y. 


South  Windsor,  Conn. 
Camden,  N.  J 


Fremont,  Ohio. 


Philadelphia,  Pa 

Pleasant  Prairie,  Wis. . 


Calexico,  Cal. 


Philadelphia,  Pa. 
Norfolk,  Ya..- 


Philadelphia,  Pa. 
New  Orleans,  La. 

Philadelphia,  Pa. 
Cincinnati,  Ohio.. 


Lewiston,  Me. 


Hollidaysburg,  Pa. 
Wilmington,  Del . . 

Brooklyn,  N.  Y... 


McKeesport,  Pa. 
Lincoln,  Nebr . . . 


Camden,  N.  J. 


Fort  Morgan,  Colo. 
Fresno,  Cal 


Hartford  City,  Ind. 
Williamsport,  Pa. . 


Coudersport,  Pa. . 
....do 


Nunda,  N.  Y... 


N.Y.... 

Azores 
Islands. 

Mass 

Md 


N.J. 


Conn. 
N.  J.. 


Ohio. 


N.C... 
Ill 


Scotland 


Poland.. 
Va 


Germany 
La 


Md 

Ohio... 


Canada . 


Russia.. 
Germany 


Va... 
Iowa. 


Poland.. 


Italy.. 


Ohio.... 
Austria . 


..do. 

..do. 


N.  Y. 


S. 
M. 


M. 

S. 
M. 

M. 


M. 


1913 

Oct.    23 


Dec.  13 
Dee.  20 


Dec.  24 


1914 

Jan.    16 


Jan.    29 


Mar.     9 


Mar.  15 
Mar.  20 


Apr. 


...do 

Apr.  11 

May     6 
May   29 

June  17 
Aug.    8 


Aug.  19 


Sept.  10 
Oct.    10 

Nov.  25 

Dec.     8 
...do.... 

Dec.  31 

1915 

Mar.  29 
Apr.     3 

Apr.     4 
Apr.   25 


May  12 
May  18 
May   24 


70 


38 
54 

60 
3 
mos. 
35 
41 


56 


Handling  dry 

hides. i 
Laborer 2 

Longshoreman 3. . 
Barber 

Fanner  * 

None 

Undertaker5 

Not  reported 

Stevedore  6 

Farmer 

Housewife 

do 

Not  reported 

Leather  worker7.. 
None 

Laborer-8 

Tailor  and  presser 

Laborer 

At  home 

Morocco  worker . . 

Laborer 9 

Liveryman 

Housewife 

laborer,  morocco 
works.  . 

None 

Laborer 10 

Merchant 

Laborer 

....do 

....do.9 


Farmer  and  stu- 
dent." 


Anthrax;     infection 

upon  the  neck. 
Anthrax. 

Anthrax;  toxemia. 
Blood  poisoning,  the 

result  of  anthrax. 
Anthrax  infection. 


Anthrax  or  malig- 
nant pustule;  tox- 
emia. 

Anthrax  (malignant 
pustule);  infected 
from  handling 
hides  in  a  local 
leather  factory. 

Rheumatism  and  an- 
thrax; pericarditis. 

Anthrax. 

Anthrax;  general  in- 
fection. 

Septicemia,  almost 
certainly  due  to  an- 
thrax in  a  cow. 

Anthrax. 

Anthrax  (malignant 
edema);  toxemia. 

Anthrax. 

Anthrax  at  base  of 
spine;  scrofula. 

Anthrax. 

Anthrax  infection  of 
face;  nephritis, 
acute. 

Endocarditis;  chron- 
ic rheumatism;  an- 
thrax. 

Malignant  pustule. 

Anthrax;  edema  of 
larynx. 

Anthrax;  infection 
bacillus  anthracis. 

Anthrax. 

Septic  infection  due 
to  anthrax  bacillus. 

Anthrax. 


Anthrax;  measles. 

Anthrax;  due  to  ba- 
cillus anthracis. 

Malignant    anthrax. 

Anthrax  causing 
edema  of  larynx, 
facial  anthrax. 

Anthrax,  internal; 
typical  case  of  true 
anthrax. 

Septic  infection; 
typical  case  of  true 
anthrax. 

Septicemia;  anthrax 
of  back. 


Special  inquiry  disclosed  that  the  actual  occupation  just  prior  to  death  was  as — 
i  Handler  of  dry  hides  in  tannery. 
2  Ranch  laborer. 

*  Longshoreman  handling  hides. 

*  Farmer  who  made  a  practice  of  butchering  cattle. 

6  Checker  and  receiver  of  horsehides  in  leather  factory. 

6  Stevedore  unloading  hair. 

'  Skin  washer  in  leather  factory. 

8  Longshoreman  unloading  hides. 

8  Laborer  in  tannery. 

i°  Farm  laborer  handling  cattle  and  cattle  hides. 

"  Schoolboy  who  also  did  chores  around  home. 


ANTHRAX    AS    AN"    OCCUPATIONAL   DISEASE. 


59 


Table 6.— DEATHS  FROM  ANTHRAX  REPORTED  IN  THE  UNITED  STATES;  1910  TO  1915 

Concluded. 


Case 
No. 

Place  of  death. 

Birth- 
place. 

Con- 
jugal 
condi- 
tion. 

Date  of 
death. 

Age. 

Occupation. 

Cause  of  death. 

105 
106 

107 
108 

Endicott,  N.  Y 

Brooklyn,  N.Y 

Russia . . 
Poland.. 

N.J 

New 
Bruns- 
wick. 
La 

M. 
M. 

S. 
S. 

s. 

1915 

June    1 

June    7 

June  29 
July     4 
July    8 

22 
35 

6 
50 
23 

Tannery  worker  l. . 

Mill  hand,  carpet 
factory. 

Not  reported 

Stevedore2 

Bacillus  anthrax; 
septicemia;  an- 
thrax. 

Anthrax  infection; 
genuine  anthrax; 
from  initial  ulcera- 
tion of  neck. 

General  asthenia 
from  anthrax  in- 
fection of  nose. 

109 

New  Orleans,  La....rf.. 

Acute  nephritis; 
edema    of    lungs; 
bacillus  anthracis; 
septicemia. 

110 

Boston,  Mass 

Russia.. 

N.Y..... 

N.  Y.... 
Md 

N.  Y.... 

N.  Y.... 

U.S.... 
N.  J.... 

U.S.... 
Minn 

N.  Y.... 

Russia . . 
Scotland 

Pa 
England 

M. 

M. 

S. 

S. 

s. 

s. 

s. 
s. 

M. 
M. 

S. 

S. 
M. 

M. 

S. 

...do 

July   29 

Aug.  24 
Aug.  30 

Sept.    3 

Sept.  29 

Oct.     7 
Oct.    12 

Oct.    15 
Oct.    22 

Nov.  12 

Nov.  18 
Nov.  20 

...do.... 

Nov.  21 

38 

34 

65 
20 

57 

23 

52 
52 

71 
35 

24 

17 
69 

49 
16 

Laborer,    freight 
yard. 3 

111 

Manhattan,  N.  Y 

Salt  Lake  City,  Utah.. 
Manhattan,  N.Y 

New  London,  Conn... 

Brentwood,  N.  Y 

Manhattan,  N.  Y 

Madison,  N.  Y 

Manhattan,  N.  Y 

Blue  Earth  Co.,  Minn. . 

Bainbridge,  N.  Y 

Manhattan,  N.  Y 

Philadelphia,  Pa 

Johnson  City,  N.  Y. .. 

fection  with  bacil- 
lus anthracis. 

112 
113 

114 

Carpenter 

Not  reported 

neck. 
Anthrax. 
Pustula  maligna  on 

under  lip;  pyemia; 

anthrax. 
Malignant    pustule; 

co  avulsions. 
Malignant     anthrax 

edema. 
Anthrax. 
Poison  from  anthrax; 

cardiac  paralysis. 

115 

None 5 

116 

117 

118 

Laborer  6 

Not  reported 

Lawver  7 

119 
120 

Housewife 

At  home  3 

External  and  inter- 
nal anthrax. 

Septicemia ;  probably 
anthrax  bacillus?. 

Anthrax. 

Septicemia  due  to 
malignant  pustule 
on  hip;  cirrhosis 
of  liver. 

Anthrax. 

Anthrax  infection; 
septicemia. 

121 

122 

123 
124 

Candv  packer 
Laborer  in  tannery 

125 

Kings  County,  Cal 

New  Brunswick,  N.  J .. 

Ohio.... 

Italy 

Poland.. 

Italy.... 

N.  Y.... 

N.Y.... 
Russia . . 

Sweden . 

M. 

M. 

M. 

M. 

S. 

s. 

M. 
W. 

Nov.  26 
...do 

Nov.  27 

...do 

Nov.  28 

Dec.     5 

Dec.  18 

Dec.  27 

56 
25 

40 

31 
25 

9 

45 

60 

Painter  9 

126 
127 

Laborer,  clay  10. . . 
Freight  handler . . . 

neck;   exhaustion. 
Cellulitis    of    neck; 

sepsis;       anthrax; 

valvular  heart 

disease. 
Anthrax;   malignant 

pustule. 

128 

129 
130 

Manhattan,  N.  Y 

Brooklyn,  N.  Y 

St.  Paul,  Minn 

Medical  student. . . 

Malignant    anthrax; 

edema. 
Malignant    pustule; 

general  septicemia. 

131 

132 

of    glottis;    acute 
cardiac  dilatation. 

( carbuncle)  on  back 
of  neck. . 

Special  inquiry  disclosed  that  the  actual  occupation  just  prior  to  death  was  as — 
i  Worker  in  leather  factory,  unloading  dry  hides. 

2  Longshoreman  working  in  hold  of  vessel  and  unloading  dried  hides. 

3  Laborer  unloading  dry  hides  at  wharves. 
*  Weigher  in  United  States  customhouse. 

6  Clerk  in  post  office. 

6  Laborer  and  driver,  and  unloading  hides  from  vessel. 

7  Retired  lawyer,  caring  for  his  own  home. 

8  Helper  on  father's  dairy  farm,  doing  housework  and  milking. 

9  Laborer  with  no  particular  ldnd  of  work. 
10  Laborer  working  in  clay  pit. 

n  Worker  in  tannery. 

12  Laborer  handling'hides  at  docks. 


60  BULLETIN"   OF    THE   BUREAU   OF    LABOR   STATISTICS. 

Individual   Histories  of  Fatal   Cases. 

In  this  section  a  more  detailed  account  is  given  of  each  of  the 
foregoing  132  cases  of  death  from  anthrax.  The  facts  were  secured 
by  correspondence  and  interviews  with  hospital  authorities  and  with 
attending  physicians,  supplemented  in  some  cases  by  visits  to  the 
family  and  friends  of  the  deceased.  By  such  inquiries  many  addi- 
tional particulars  were  obtained  which  were  important  as  throwing 
light  on  the  relation  between  occupation  and  cause  of  death. 

No.  1,  of  Elkland,  Pa.,  died  at  the  age  of  39  on  January  2,  1910,  of  "  an- 
thrax (external)  ;  tetanus."  He  was  a  carpenter  at  a  tannery,  and  upon 
contracting  the  infection  from  hides  was  sent  to  Elmira,  N.  Y.,  to  be  treated 
by  a  physician  who  had  previously  practiced  near  Elkland  and  had  had  much 
experience  with  anthrax.  "  I  think,"  says  the  physician,  "  he  would  have 
recovered  from  anthrax  if  tetanus  had  not  developed  about  two  weeks  after 
the  appearance  of  anthrax  symptoms ;  he  lived  only  24  hours  from  the  time 
tetanus  developed.  Of  course  he  probably  would  not  have  developed  tetanus 
if  he  had  not  suffered  from  anthrax  first."  As  near  as  the  physician  could 
find  out  the  diseased  hides  "  were  imported  from  South  American  countries, 
and  from  cattle  that  had  died  of  anthrax."  The  physician  further  states  that 
in  five  years'  practice  near  Elkland  he  treated  "  quite  a  number  of  cases  suffering 
from  anthrax  contracted  by  employees  handling  hides  "  at  the  tanneries  of  three 
neighboring  towns,  and  that  this  was  his  "  first  case  that  succumbed  to  the 
disease." 

No.  2,  of  Wilmington,  Del.,  died  at  the  age  of  50  on  January  10,  1910,  of 
"  anthrax."    He  was  a  morocco  worker  by  trade. 

No.  3,  of  San  Francisco,  Cal.,  died  at  the  age  of  24  on  January  11^  1910, 
of  "  exhaustion ;  anthrax."  He  was  a  laborer  in  a  tannery,  where,  according 
to  the  physician,  he  became  infected  by  hides.  The  illness  lasted  only  three 
days,  and  death  occurred  in  a  hospital. 

No.  4,  of  Boston,  Mass.,  died  at  the  age  of  34  on  January  29,  1910,  of  "  an- 
thrax." He  was  a  freight  handler.  His  right  arm  was  affected.  Upon  admis- 
sion to  the  hospital  an  excision  of  the  affected  area  was  made.  Serum  was  not 
used.  A  pure  growth  of  anthrax  bacilli  was  obtained  from  the  blood.  He  had 
been  in  the  hospital  about  a  day  when  death  occurred. 

No.  5,  of  'Philadelphia,  Pa.,  died  at  the  age  of  32  on  February  15,  1910,  of 
"  anthrax."  For  six  weeks  preceding  his  illness  he  had  worked  as  a  laborer 
in  a  tannery.  According  to  the  hospital  physician,  the  disease  began  three 
weeks  prior  to  his  admission  to  the  hospital  "  with  a  small  pustular  eruption 
on  the  face.  Next  day  the  neck  became  edematous,  until  on  admission  the 
whole  neck  was  purplish  in  color  and  doughy  to  the  feel."  He  died  on  the 
day  he  was  admitted  to  the  hospital. 

No.  6,  of  Jackson,  Ohio,  died  at  the  age  of  68  on  March  8,  1910,  of  "  septi- 
cemia ;  anthrax  and  Bright's."     She  was  a  housewife. 

No.  7,  of  Williamsport,  Pa.,  died  at  the  age  of  51  on  March  28,  1910,  of 
"  anthrax."  The  physician  states  that  the  man  came  in  contact  with  raw 
sheep  wool  of  American  origin,  and  that  he  probably  was  a  wool  sorter.  The 
disease  took  the  form  of  "  malignant  pustule — external  anthrax,"  according  to 
the  physician,  who  goes  on  to  say  :  "  He  had  all  the  classic  symptoms,  especially 
a  marked  edema  of  shoulder  which  spread  to  face  and  breast.  He  lived  about 
five  days.  Crucial  incisions  were  made  about  shoulder  and  breast.  No  relief 
was  derived  from  this  treatment."  Anthrax  bacilli  were  found.  Antianthrax 
serum  was  not  available  at  the  hospital  where  the  patient  was  treated. 


ANTHRAX   AS   AN    OCCUPATIONAL   DISEASE.  61 

No.  8,  of  Pierceton,  Ind.,  died  at  the  age  of  52  on  April  1,  1910,  of  "  anthrax ' 
heart  failure."  His  occupation  was  law  and  farming,  and  death  followed 
within  five  days,  the  physician  states,  after  "  bite  of  fly."  A  carbuncle  ap- 
peared on  the  cheek,  with  "  papules,  pustule,  vesicles,  great  induration." 
Phenol  (carbolic  acid)  was  injected  and  stimulants  were  given.  When  asked 
whether  antianthrax  serum  was  injected  the  physician  replied :  "  No ;  none 
to  be  had." 

No.  9,  of  Reading,  Pa.,  died  at  the  age  of  49  on  April  22,  1910,  of  "  anthrax." 
According  to  the  physician  the  patient  "  was  the  mother  of  a  large  family,  and 
a  hard-working  housewife.  She  claimed  to  become  infected  through  an  abra- 
sion of  the  skin  of  the  back.  She  was  treated  in  the  beginning  by  domestic 
remedies.  When  I  saw  the  case  the  patient  was  so  weak  and  the  slough  so 
large  that  I  made  no  attempt  at  excision."  Her  husband  states  that  the  de- 
ceased had  been  a  cigarmaker  for  a  few  years  before  her  marriage. 

No.  10,  of  Wilmington,  Del.,  died  at  the  age  of  17  on  June  4,  1910,  of 
"  anthrax."  He  was  employed  at  $1.75  a  day  by  a  large  morocco  firm  and  came 
in  contact  with  goat  skins  imported  from  South  America  and  from  China. 
The  skins,  according  to  the  physician,  were  washed,  but  not  disinfected,  before 
the  boy  handled  them ;  hot  water,  gloves,  nailbrushes,  and  disinfectants  were 
provided  for  the  workers.  Bloodstained  materials  were  eliminated  "  as  far 
as  possible,"  but  there  was  no  special  ventilation.  The  illness  lasted  four  days. 
"  When  he  sent  for  me,"  declares  the  physician,  "  I  found  the  pustule  on  his 
right  chest,  which,  with  the  history  of  his  working  in  the  morocco  factory,  I 
decided  was  probably  anthrax.  A  slide  confirmed  it."  That  is,  anthrax  bacilli 
were  found  by  microscopic  examination.  "  The  course  was  very  rapid,"  con- 
tinues the  medical  man,  "  the  people  poor  and  could  not  afford  serum  treat- 
ment, and  he  died.  I  cut  out  the  pustule,  but  it  did  him  no  good."  No  in- 
demnity was  received  by  the  family  for  the  boy's  death. 

No.  11,  of  Latrobe,  Pa.,  died  at  the  age  of  34  on  June  29,  1910,  of  "  anthrax ; 
septic  intoxication."  He  was  a  laborer  in  a  paper  mill,  his  duties,  according  to 
one  who  was  connected  with  the  mill  at  the  time,  being  to  unload  baled  rags  from 
cars  and  to  truck  them  into  the  storage  sheds  and  to  the  cutting  room,  where 
the  rag  cutters  would  cut  the  bales  open  and  feed  the  rags  into  the  cutting  ma- 
chines. The  rags  were  principally  cotton,  coming  in  the  main  from  "  all  parts  of 
the  United  States  and  Canada,"  but  occasionally  as  many  as  "  50  cars  of  foreign 
rags  "  would  arrive  at  one  time  from  England,  Germany,  France,  Ireland,  and 
Spain.  The  rags  were  "  never  treated  with  any  disinfectant  "  or  cleaned.  This 
man's  work  was  done  in  the  open  air,  on  a  platform  which  was  "  cleaned  as 
often  as  needed."  No  hot  water,  gloves,  nailbrushes,  or  disinfectants  were  pro- 
vided ;  in  fact,  says  the  informant,  "  there  has  never  been  any  precaution  taken 
in  regard  to  the  prevention  of  disease."  The  man  went  for  treatment  to  a  hos- 
pital in  Greensburg,  Pa.  The  physician  in  charge  of  the  case  states  that  the 
clinical  symptoms  were  so  typical  that  he  holds  the  case  was  one  of  anthrax. 
"  Two  of  my  colleagues  who  saw  the  case  with  me  are  of  the  same  opinion. 
The  man  had  a  virulent  infection  above  the  ankle.  There  was  at  this  point  a 
circular  area,  probably  2  inches  in  diameter,  much  reddened  and  elevated,  with 
a  rather  clear  serous  and  somewhat  depressed  center.  There  was  a  marked 
lymphangitis  extending  up  the  leg  and  thigh.  The  man  was  profoundly  toxic 
and  had  a  high  temperature  range.  When  the  diagnosis  was  made,  which  was 
very  soon  after  his  admission  to  the  hospital,  he  was  removed  to  a  tent  which  I 
had  erected  in  the  yard,  and  there  he  died  during  the  night  following  admission." 
The  duration  of  the  illness  was  10  days.  Antianthrax  serum  was  not  available 
for  injection. 


62  BULLETIN   OF   THE   BUBEAU    OE    LABOR  STATISTICS. 

"  No.  12,  of  Howe,  Pa.,  died  at  the  age  of  52  on  July  19,  1910,  of  "  anthrax ; 
skinning  a  cow  dead  with  the  disease."  The  man's  occupation  is  given  merely 
as  "  laborer."     Illness  lasted  five  days. 

No.  13,  of  Philadelphia,  Pa.,  died  at  the  age  of  60  on  August  8,  1910,  of 
"  anthrax ;  bronchitis."  The  disease  lasted  eight  days.  The  patient  was  a 
widow.    No  occupation  is  given  on  the  death  certificate. 

No.  14,  of  South  Hadley,  Mass.,  died  at  the  age  of  15,  on  August  20,  1910, 
of  "  general  sepsis ;  anthrax."  According  to  the  physician,  he  was  employed  at 
$1.35  a  day  as  bleach  boy  in  the  rag  room  of  a  paper  mill,  but  some  time  after 
the  occurrence  the  superintendent  of  the  mill  is  reported  to  have  asserted  that, 
while  the  boy  "  had  access  to  the  rag  room  and  was  probably  there,  he  was  not 
supposed  to  be  there."  The  physician  states  that,  although  the  rags  used  were 
imported  from  France  and  Italy,  they  were  "  all  new  clippings."  The  physician's 
story  indicates  infection  through  a  scratched  arm.  "  On  Saturday  night,  August 
13,"  he  says,  "patient  slept  out  of  doors  in  a  tent."  The  next  morning  he 
"  noticed  an  '  insect  bite '  on  middle  of  left  forearm  which  was  swollen  and 
extremely  itchy."  On  Monday  he  returned  from  work  "  in  the  middle  of  the 
forenoon,  feeling  sick.  Had  a  chill,  nausea,  and  vomiting."  The  physician  saw 
the  patient  first  on  Wednesday  afternoon.  He  "  had  some  fever  and  increased 
pulse  rate."  On  the  left  forearm  was  a  small  localized  swelling  that  looked  like 
a  boil ;  "  rest  of  arm  was  normal,  but  left  axillary  glands  and  the  whole  left 
chest  wall  was  swollen.  Patient  had  an  extremely  septic  look."  Under  local 
treatment  and  catharsis  the  patient  apparently  improved  for  one  day,  but 
Friday  morning  he  was  worse.  The  swelling  was  opened,  and  a  very  small 
amount  of  pus  obtained.  "  Friday  night  patient  was  very  restless  and  looked 
very  sick.  Temperature  and  pulse  were  both  high,  and  patient  was  vomiting. 
Saturday  morning  patient  was  in  a  state  of  collapse — subnormal  temperature, 
and  radial  pulse  absent  until  stimulated  with  strychnia  and  camphor.  Skin  was 
a  dark  livid  red,  cold,  and  covered  with  sweat.  Was  still  vomiting  and  passing 
black  urine.  It  was  not  until  now  that  I  suspected  anthrax."  The  patient  was 
removed  to  a  hospital  in  Holyoke,  Mass.,  and  a  consultant  called.  "  Excised 
localized  area  (about  2  inches  in  diameter)  and  swabbed  surface  with  pure 
carbolic  acid  followed  with  alcohol.  Swelling  involved  only  the  skin  and  sub- 
cutaneous tissue.  Patient  died  Saturday  night."  The  excised  specimen  was  sent 
to  Harvard  for  diagnosis,  and  the  report  was  anthrax. 

No.  15,  of  Maple  Hill,  Kans.,  died  at  the  age  of  46  on  October  2,  1910,  of 
"  anthrax.-"  He  was  a  ranch  foreman,  and  according  to  the  physician's  state- 
ment "  infection  was  through  the  skin  in  the  forearm,"  where  the  man  "  had 
a  little  abrasion."  Three  or  four  days  before  the  disease  broke  out  he  "  helped 
to  skin  and  take  care  of  a  dead  cow,"  and  it  is  supposed  that  he  "  got  the 
infection  at  that  time."  Death  occurred  in  a  hospital  at  La  Junta,  Colo., 
after  five  days'  illness,  the  disease  taking  the  form  of  "  malignant  anthrax 
edema." 

No.  16,  of  Fairport,  Ohio,  died  at  the  age  of  4  months  11  days  on  October 
13,  1910,  of  "  cramps — disease  of  bowel ;  anthrax."  How  this  infant  girl  con- 
tracted the  disease  the  physician  was  unable  to  state. 

No.  17,  of  Baltimore,  Md.,  died  at  the  age  of  62  on  December  2,  1910,  of 
"toxemia;  anthrax."  He  was  employed  at  mixing  animal  hair  in  machines, 
preparatory  to  spinning.     Illness  was  fatal  after  two  days. 

No.  18,  of  Pomona.  Gal.,  a  retired  farmer,  died  at  the  age  of  72  on  December 
8.  1910,  of  "  anthrax ;  senility,"  according  to  the  official  death  certificate. 

No.  19,  of  Newcastle,  Pa.,  died  at  the  age  of  78  on  December  19,  1910,  of 
"  anthrax ;  exhaustion  following  the  disease."  The  deceased  was  a  baker, 
and  death  occurred  in  a  hospital  after  an  illness  of  one  month's  duration. 


ANTHRAX    AS   AX    OCCUPATIONAL   DISEASE.  63 

No.  20,  of  Breesport,  N.  Y.,  died  at  the  age  of  48  on  December  22,  1910; 
of  "  anthrax,  external,  and  general  toxemia."  He  was  employed  by  a  leather 
company  and  handled  hides,  which  the  physician  thinks  were  imported  from 
Australia.  For  the  purpose  of  treatment  he  was  taken  to  Elmira,  N.  Y. 
"The  local  lesion,"  says  the  doctor,  "  was  single  and  situated  under  the 
lower  jaw,  about  over  the  submaxillary  gland.  Undoubtedly  infection  gained 
access  through  abrasion  of  the  skin  at  that  point.  He  rapidly  became  toxic 
and  unconscious  and  died  within  a  few  days  from  onset  of  constitutional 
symptoms.  The  local  symptoms  were  first  papular,  then  rapidly  vesicular, 
with  an  area  of  cellulitis,  and  soon  local  gangrene." 

No.  21,  of  Fresno,  Cal.,  died  at  the  age  of  52,  on  December  28,  1910,  of 
"  anthrax  followed  by  septic  abscesses  and  pyemia."  His  occupation  is  given 
as  barber. 

No.  22,  of  Kittery,  Me.,  died  at  the  age  of  24,  on  December  29,  1910,  of  "  septi- 
cemia with  malignant  pustule."  He  was  a  farmer,  but  the  mode  of  infection 
could  not  be  ascertained.  The  physician  states  that  he  displayed  "all  the 
typical  clinical  symptoms."    Death  occurred  after  three  days'  illness. 

No.  23,  of  Canastota,  N.  Y.,  died  at  the  age  of  75,  on  January  27,  1911,  of 
w  anemia ;  malignant  pustule,  right  cheek."  For  much  of  his  life  he  had 
worked  as  a  cigar  maker,  but  at  the  time  of  his  death  had  retired.  Anti- 
anthrax  serum  was  not  available. 

No.  24,  of  Waterford,  Vt,  died  at  the  age  of  29,  on  February  28,  1911,  of 
"  anthrax."  He  did  farm  work  about  the  neighborhood.  According  to  the  phy- 
sician, eight  days  before  the  man's  death  "  malignant  pustule "  appeared  in 
the  form  of  "  pimple  on  face,"  contracted  by  "  contagion  from  a  sick  cow." 
Curative  serum  was  not  available.    There  were  no  dependents. 

No.  25,  of  Harrison,  Ind.,  died  at  the  age  of  62,  on  April  28, 1911,  of  "  anthrax ; 
septicemia."  His  occupation  is  given  as  "  laborer."  Illness  lasted,  according 
to  the  official  death  certificate.  21  days. 

No.  26,  of  Youngsville,  La.,  died  at  the  age  of  34,  on  April  28,  1911,  of 
"  anthrax."  Deceased  was  a  farmer.  The  record  at  the  New  Orleans  hospital 
to  which  he  was  sent  furnishes  these  data :  "  Patient  admitted  to  ward  in 
delirious  state.  "Was  unable  to  give  coherent  account  of  illness.  Friend,  who 
accompanied  him  to  hospital,  said  that  eight  days  prior  to  admission  a  small 
sore  like  a. boil  appeared  on  bridge  of  nose  (this  told  him  by  patient's  wife). 
The  inflammation  process  spread  rapidly  and  involved  the  skin  of  forehead  and 
both  eyelids,  together  with  some  of  the  skin  covering  cheeks,  in  a  gangrenous 
process  with  necrosis  and  sloughing  pustules  here  and  there.  Patient  gradu- 
ally grew  worse  and  died."  The  eyes  were  "  closed  by  exudate  from  skin 
lesion,"  and  "  punched-out  ulcers  with  undermined  edges"  were  found  on  nose 
and  forehead.  Anthrax  bacilli  were  found.  The  patient  had  skinned  a  dead 
cow  some  time  before  he  became  ill. 

No.  27,  of  Windham  County,  Conn.,  died  at  the  age  of  72,  on  May  7.  1911.  of 
"anthrax."  He  was  a  self -employing  tailor,  and  was  partially  supported  by 
an  Army  pension  of  about  $12  a  month.  His  work  consisted  of  "  mending  and 
pressing  old  clothes,"  states  the  physician.  No  antianthrax  serum  was  avail- 
able. 

No.  28,  of  New  Britain,  Conn.,  died  at  the  age  of  52,  on  May   16,   191  ' 
"anthrax     (malignant    pustule);    septicemia."      Her    occupation    is    given    as 
housekeeper. 

No.  29,  of  Lynn,  Mass.,  died  at  the  age  of  38.  on  May  30,  1911,  of  "  anthrax  ; 
pulmonary  tuberculosis."     His  occupation  is  given  only  ;is  laborer.     Prom  tlit; 
hospital  record  it  is  learned  that  the  patient  went  to  the  accident  room  "  with 
42806°— Bull.  205—17 5 


64  BULLETIN"   OF    THE   BUREAU   OF    LABOR    STATISTICS. 

a  small  red  spot  on  right  cheek  which  he  had  had  for  two  days."  There  was 
also  small  swelling  and  redness  around  the  spot.  A  "  slide  was  taken  and 
anthrax  bacilli  found."  The  patient,  however,  refused  treatment  and  went 
home,  saying  he  would  return  in  an  hour.  He  did  not-  go  back  until  the  follow- 
ing morning,  when  the  spot  had  "  increased  in  size,  swelling  greatly  in- 
creased, and  some  edema."  Excision  was  then  performed  under  ether,  the 
wound  cauterized  with  carbolic  acid,  and  corrosive  poultices  applied.  The 
man  died  on  the  fourth  day  after  first  applying  at  the  hospital. 

No.  30,  of  Cleveland,  Ohio,  died  at  the  age  of  40,  on  June  21,  1911,  of 
"  malignant  pustule ;  edema  of  glottis."  He  was  a  traveling  musician,  "  with 
a  circus  "  at  the  time  of  infection,  the  physician  is  sure.  While  in  a  Pennsyl- 
vania city  he  "  had  a  small  infection  on  upper  lip  which  he  squeezed ;  following 
this  the  infection  rapidly  involved  the  whole  upper  lip,  and  he  was  advised  to 
hurry  home."  When  called  the  physician  "  recognized  a  very  severe  infection 
with  rapidly  extending  edema  involving  cheek  and  eye,  temperature  105°, 
with  extremely  rapid  pulse."  Treatment  consisted  in  local  injections  of  car- 
bolic acid,  ichthyol  applications  to  his  face,  which  was  edematous,  with  tem- 
perature baths  and  supportive  treatment ;  medication  mostly  by  hypodermic  in- 
jection. "  A  strong  attempt  was  made  to  get  anthrax  vaccine,  locally  and 
by  telegraph."  One  firm  sent  a  supply  through  a  local  representative,  "  but 
patient  died  before  application  could  be  made."  The  history  of  the  patient's 
"  traveling  with  the  circus,  his  fondness  for  horses  (by  his  own  statement),  the 
initial  lesion  with  extremely  rapid  progress  of  disease,  characteristic  pustule, 
gangrenous,  vicious  appearing  ulcer,  high  temperature,  and  rapid  disinte- 
gration," are  considered  by  the  physician  convincing  evidence  of  anthrax. 

No.  31,  of  Monterey,  Cal.,  died  at  the  age  of  38,  on  July  10,  1911,  of  "  an- 
thrax ;  acute  uremia."    The  statement  of  occupation  is  merely  "  laborer." 

No.  32,  of  Dubois,  Pa.,  died  at  the  age  of  38,  on  July  28,  1911,  of  "  anthrax ; 
anthrax  edema."  Under  the  head  of  occupation  the  death  certificate  says, 
"  None." 

No.  33,  of  Bakersfield,  Cal.,  died  at  the  age  of  42,  on  October  16,  1911,  of 
"  anthrax."  The  woman  lived  on  a  farm  16  miles  from  town.  A  pustule  broke 
out  on  her  neck,  but  she  paid  little  attention  to  it  for  10  days,  when  she  called 
a  physician,  who  pronounced  it  anthrax.  "  It  seems,"  says  the  medical  man, 
"  a  sheep  had  died  in  the  neighborhood,  and  as  there  was  an  abundance  of  flies 
in  the  house  there  is  no  doubt  that  the  infection  was  carried  by  the  flies." 
Death  occurred  on  the  fifth  day  of  treatment.     There  were  two  dependents. 

No.  34,  of  Philadelphia,  Pa.,  died  at  the  age  of  38,  on  November  7,  1911,  of 
"  anthrax ;  due  to  bacillus  anthracis."    His  occupation  is  given  as  laborer. 

No.  35,  of  Wilmington,  Del.,  died  at  the  age  of  48,  on  November  20,  1911,  of 
"  anthrax."  For  two  years  previously  he  had  been  employed  as  an  assorter  of 
hides  in  a  morocco  works,  at  $1.20  a  day.  The  hides  were  imported  in  a  raw 
state,  and,  according  to  the  physician,  were  domestic  cleaned,  but  the  cleanli- 
ness of  the  workroom  was  "  not  what  it  should  be "  and  no  gloves  or  nail- 
brushes were  provided.  The  patient  "  showed  all  the  symptoms  of  anthrax  " ; 
no  test  for  bacteria  was  made.  Antianthrax  serum  was  injected,  but  "  too 
late."  The  wife  and  four  dependent  children  received  no  indemnity  beyond 
funeral  expenses. 

No.  36,  of  New  Orleans,  La.,  died  at  the  age  of  25,  on  December  27,  1911,  of 
"anthrax  (carbuncle);  malignant  pustule."  He  was  a  salesman  for  an  elec- 
trical supply  house.  The  attack  lasted  10  days,  appearing  first,  the  hospital 
physician  says,  as  "  infection  on  upper  lip,  right  side."  It  then  "  spread  to  nose 
and  face  of  same  side;  subsided  after  drainage  and  cauterization,  followed  by 


ANTHRAX   AS  AN    OCCUPATIONAL   DISEASE.  65 

ichthyol  dressing."  The  final  symptoms  were  "  rapid  invasion  of  other  side  of 
face,  neck,  chest,  pharynx,  etc."     Serum  treatment  was  not  utilized. 

No.  37,  of  Logan  County,  Ky.,  died  at  the  age  of  51,  on  February  3,  1912,  of 
"  malignant  pustule ;  heart  paralysis."  The  woman's  occupation  is  not  given 
on  the  official  death  blank. 

No.  38,  of  Philadelphia,  Pa.,  died  at  the  age  of  52,  on  February  6,  1912,  of 
"  anthrax."  He  was  a  bristle  comber  and  hair  dyer,  earning  $1.50  a  day,  and 
the  materials  he  worked  with  came  from  Siberia.  The  illness  lasted  seven 
days,  but  the  doctor  in  the  case  states  that  the  man  "  had  no  physician  until 
the  day  before  his  death,  when  I  was  called  in  to  attend  him."  Six  days 
before  he  had  noticed  a  pimple  on  the  back  of  his  neck,  but  "  thought  it  of 
little  consequence,  working  every  day  and  using  antiphlogistine,  and  in  fact 
intended  to  work  the  day  before  his  death,  but  feeling  very  sick  he  sent  for 
me."  On  examination  the  physician  found  on  the  back  of  the  patient's  neck 
what  at  first  seemed  to  be  a  carbuncle,  but  closer  observation  proved  it  was 
not  one.  It  was  probably  anthrax.  The  man  was  "  suffering  severe  pain  and 
had  every  evidence  of  septic  infection."  A  few  hours  later  excision  was  per- 
formed, which  the  patient  said  gave  him  great  relief,  "  as  if  a  bar  of  iron 
had  been  removed  from  his  neck."  The  following  morning  the  physician  "  was 
called  early  and  found  him  in  extremis."  Examination  of  the  specimen  re- 
moved showed  anthrax. 

No.  39,  of  Mesopotamia,  Ohio,  died  at  the  age  of  30,  on  February  13,  1912, 
of  "malignant  pustule  on  right  side  of  face;  abscess  of  right  kidney."  She 
was  a  housewife,  and  the  physician's  history  shows  a  long  period  of  neglect  of 
initial  symptoms,  "  as  her  people  were  strong  Christian  Scientists."  When  a 
medical  man  was  finally  summoned  he  found  a  temperature  of  "  about  103£°, 
pulse  110;  patient  went  from  bad  to  worse,  until  death  finally  ended  the 
scene." 

No.  40,  of  Philadelphia,  Pa.,  died  at  the  age  of  47,  on  March  2,  1912,  of  "  an- 
thrax." Death  occurred  in  a  hospital.  The  man's  occupation  is  given  as 
hairdresser. 

No.  41,  of  Wilmington,  Del.,  died  at  the  age  of  19,  on  March  6,  1912,  of 
"  anthrax."  He  was  a  morocco  worker,  probably  in  the  beam  house.  The 
pustule  appeared  at  the  angle  of  the  jaw,  and  caused  death  by  strangulation 
in  48  hours. 

No.  42,  of  Toledo,  Ohio,  died  at  the  age  of  57,  on  March  7,  1912,  of  "ex- 
haustion from  chronic  cystitis ;  blood  poisoning ;  anthrax,  malignant  pustules 
on  leg  and  hand."  Nothing  more  definite  than  "  laborer "  is  given  as  his 
occupation.     Death  occurred  in  a  hospital. 

No.  43,  of  Boston,  Mass.,  died  at  the  age  of  26,  on  March  9,  1912,  of  "  sep- 
ticemia ;  anthrax."  He  was  a  longshoreman,  and  for  some  time  preceding 
the  date  of  infection  had  been  handling  hides.  The  assistant  superintendent 
of  the  hospital  where  he  died  on  the  day  after  admission  and  three  days 
after  the  beginning  of  the  attack  states  that  the  disease  took  the  form  of  a 
"  small  pimple,  increasing  until  sides  of  face  became  swollen."  Examination 
disclosed  "  very  numerous,  very  large  bacilli — bacillus  anthracis."  Treatment 
was  by  excision  of  a  "  wide  area  about  pustule." 

No.  44,  of  New  York,  N.  Y.,  died  at  the  age  of  18  on  June  2,  1912,  of  "  malig- 
nant pustule."  As  far  as  the  physician  can  recollect  she  was  a  school-teacher, 
"  well  developed,  and  in  good  physical  condition,  with  a  previous  good  history." 
She  had  been  "  bit  by  a  mosquito  on  the  left  cheek  immediately  below  the 
mouth."  On  the  following  day  there  was  observed  a  "  hard,  tense  swelling," 
which  in  three  or  four  days  became  "  much  worse,  much  bigger,  and  exceedingly 


66  BULLETIN   OF    THE   BUREAU    OF   LABOR  STATISTICS. 

painful."  The  mass  was  opened,  but  as  there  was  no  improvement  a  second  and 
more  extensive  operation  was  performed  the  next  morning.  "  The  patient  was 
given  appropriate  vaccine  treatment  and  everything  was  done  for  her,  but  she 
died  on  the  following  day." 

No.  45,  of  Cincinnati,  Ohio,  died  at  the  age  of  81  on  July  23,  1912,  of  "  anthrax 
or  carbuncle  ;  septicemia  and  asthenia."     He  was  a  retired  pilot. 

No.  46,  of  Allegheny  County,  Pa.,  died  at  the  age  of  55  on  August  6,  1912,  of 
"  anthrax."  The  physician  who  made  out  the  death  certificate  gave  the  occupa- 
tion as  foreman,  but  did  not  state  in  what  kind  of  an  establishment  he  worked. 

No.  47,  of  Orange,  N.  J.,  died  at  the  age  of  52,  on  September  13,  1912,  of 
"  inoculation  by  anthrax  bacilli,  causing  general  systemic  poisoning."  He  was  a 
veterinary  surgeon,  and  the  medical  record  of  the  case  is  so  clear  and  striking 
that  it  deserves  to  be  quoted  at  length.  When  the  patient  first  went  to  secure 
medical  advice  he  had,  reports  the  physician,  "  a  brownish  spot  at  his  left  wrist 
about  the  size  of  a  wart,  and  his  left  forearm  was  swollen  and  edematous  up  to 
the  elbow.  He  gave  a  history  of  performing  an  autopsy,  on  some  cows  about 
12  days  or  more  previous  to  seeing  me,  at  which  time  he  scratched  his  right 
forefinger,  but  at  once  cauterized  it.  Nothing  developed  at  this  spot,  but  it 
seems  probable  that  he  must  have  scratched  himself  on  the  left  wrist  at  the 
same  time  without  knowing  it."  However,  "  no  symptoms  of  any  kind  developed 
for  at  least  a  week  or  more  after  the  autopsy,  and  I  think  it  was  nearly  two 
weeks  afterwards  that  he  first  saw  me.  That  morning  (September  9)  he  walked 
into  my  office  not  looking  sick  and  with  a  normal  temperature  and  pulse,  and  his 
forearm,  though  swollen  and  tense,  was  not  angry  looking."  The  physician  did 
not  know  what  to  make  of  his  condition  and  immediately  consulted  two  other 
surgeons,  who  agreed  with  him  that  "  there  was  evidently  some  form  of  infec- 
tion, but  none  of  us  knew  what  it  was."  The  patient  was  consequently  taken  to 
a  local  hospital,  where  the  pathologist  took  a  culture  from  the  "wartlike 
brownish  spot  at  the  wrist "  and  reported  next  morning  that  the  culture 
"  showed  anthrax  bacilli."  By  this  time  the  swelling  had  "  extended  2  inches 
above  the  elbow,  and  the  spot  at  the  wrist  was  as  big  as  a  quarter."  A  physi- 
cian from  a  large  New  York  hospital  was  called  in  consultation,  who  advised 
that  a  few  drops  of  blood  from  the  patient's  right  ear  be  taken  for  examination. 
This  was  done,  "  and  the  slide  showed  anthrax  bacilli,  which  indicated  that 
the  bacilli  were  then  in  the  general  circulation."  The  patient  was  again  taken 
to  the  local  hospital,  where  that  afternoon  the  New  York  practitioner  operated, 
cutting  out  the  original  focus  at  the  left  wrist  and  making  long  incisions  in  the 
arm  and  forearm.  No  pus  was  found,  but  the  incisions  were  made  to  relieve 
the  tension  and  promote  drainage.  Though  this  operation  was  performed  within 
30  hours  after  the  patient  first  presented  himself  for  treatment,  there  was  little 
hope  that  it  would  save  him,  as  the  bacilli  were  all  through  the  system,  as 
evidenced  by  the  blood  taken  from  the  lobe  of  the  right  ear.  "A  Philadelphia 
firm  supplied  through  special  messenger  some  anthrax  serum  made  in  Italy 
(I  believe),  and  this  was  injected  subcutaneously  in  large  doses  and  repeated 
at  intervals.  No  instructions  were  given  at  first  as  to  the  method  of  injection, 
but  latterly  the  serum  was  injected  directly  into  the  veins  as  advised.  In  spite 
of  all  that  was  done,  the  patient  gradually  grew  weaker  and  died  quietly  in 
bed  September  13,  1912."  The  infected  spot,  adds  the  physician  first  consulted, 
"  was  unlike  anything  I  have  ever  seen,  and  its  extraordinary  development 
within  24  hours  was  a  sight  not  likely  to  be  forgotten." 

No.  48,  of  Stoddard  County,  Mo.,  died  in  Richland,  Mo.,  at  the  age  of  59, 
on  October  14,  1912,  of  "  anthrax."    Deceased  was  a  farmer. 

No.  49,  of  Philadelphia,  Pa.,  died  at  the  age  of  34  on  November  14,  1912,  of 
"  anthrax."    The  man  was  a  laborer  in  a  tannery  and  was  admitted  to  a 


ANTHRAX   AS  AN    OCCUPATIONAL   DISEASE.  67 

hospital  on  the  fourth  day  of  the  attack  with  "  anthrax  lesion  on  neck."  He 
died  the  following  day,  leaving  a  widow. 

No.  50,  of  Peabody,  Mass.,  died  at  the  age  of  20,  on  November  18,  1912, 
of  "  anthrax."  He  had  worked  for  about  a  year  as  a  "  lumper  "  in  the  color- 
ing room  in  a  morocco  and  calfskin  tannery,  at  $1.50  a  day.  According  to 
the  hospital  physician  there  was  no  special  ventilation,  but  the  workroom 
was  cleaned  daily  and  hot  water  was  provided,  also  bichloride  of  mercury  as  a 
disinfectant.  The  disease  took  the  form  of  "  pustule,  immense  swelling."  The 
pustule  was  cut  out  under  local  anesthetic,  but  death  resulted  suddenly  from 
"  embolism ;  blood  vessels  obstructed  at  site  of  swelling."  From  the  indus- 
trial accident  board  which  administers  the  workmen's  compensation  act  in  his 
State  it  was  learned  that  the  pustule  appeared  on  the  right  breast.  On  No- 
vember 18  the  man  "  told  the  foreman  when  he  went  home  at  night  that 
he  felt  sick."  Two  days  later  he  called  a  physician,  and  he  was  removed 
to  the  hospital,  where  he  died  next  morning.  The  man  was  married,  and 
his  dependents  were  entitled  to  compensation,  but  lived  in  Europe  and  the 
accident  board  was  unable  to  locate  them. 

No.  51,  of  St.  Paul,  Minn.,  died  at  the  age  of  7,  on  November  20,  1912,  of 
"  malignant  pustule ;  blood  poisoning."  The  patient  was  a  schoolgirl,  and  the 
hospital  authorities  "  do  not  know  how  the  disease  was  acquired."  Illness 
lasted  14  days;  antianthrax  serum  was  not  available. 

No.  52,  of  Graves  County,  Ky.,  died  at  the  age  of  17,  on  December  4,  1912, 
of  "  anthrax."    She  was  a  housekeeper. 

No.  53,  of  Ballard  County,  Ky.,  died  at  the  age  of  28,  on  December  23,  1912, 
of  "  anthrax."    Her  occupation  is  given  as  housewife. 

No.  54,  of  Wilmington,  Del.,  died  at  the  age  of  39,  on  January  19,  1913,  of 
"malignant  pustule."    He  was  a  stationary  engineer  in  a  large  morocco  works. 

No.  55,  of  Philadelphia,  Pa.,  died  at  the  age  of  30,  on  January  23,  1913, 
of  "  anthrax  carbuncle  of  neck."  He  had  worked  for  only  eight  months  at 
the  establishment  where  he  contracted  the  fatal  infection.  The  uncle  with 
whom  he  lived  states  that  he  complained  of  having  a  painful  neck  two  da3rs 
before  he  called  a  physician,  death  occurring  within  the  succeeding  24  hours. 
The  coroner's  inquest  developed  the  following  information :  Deceased  earned 
$9  a  week  working  as  a  laborer  about  a  factory  where  "  curled  hair  was 
handled."  Most  of  the  hair  was  imported  from  Russia,  South  America,  and 
England.  The  firm  stated  that  "  the  usual  precaution,  by  sterilizing  the  hair, 
had  been  taken."  According  to  the  coroner  the  firm  "  supplies  freely  serum 
imported  from  Italy,"  but  the  man  and  his  uncle."  apparently,  neglected  avail- 
able means  of  treatment  until  too  late." 

No.  56,  of  Philadelphia,  Pa.,  died  at  the  age  of  55,  on  February  13,  1913,  of 
"  anthrax."  He  was  a  longshoreman,  and  seven  days  before  death  had  loaded 
hides  and  wool.  First  symptoms  appeared  seven  days  before  death,  in  the 
form  of  "  pimple  on  right  cheek."  On  the  day  of  his  death  the  patient  was 
ordered  removed  to  a  hospital,  but  died  before  the  arrival  of  the  ambulance. 

No.  57,  of  Snohomish  County,  Wash.,  died  at  the  age  of  58,  on  February  15, 
1912,  of  "  anthrax  of  right  hand."    She  was  a  housewife. 

No.  58,  of  Gloversville,  N.  Y.,  died  at  the  age  of  37,  on  March  1,  1913.  of 
"  anthrax ;  edema  of  glottis."  Deceased  was  by  trade  a  molder  in  a  foundry, 
but  at  the  time  of  contracting  the  disease  had  been  employed  about  six  months 
in  a  leather-dressing  establishment,  liming  skins  and  as  general  helper.  Here, 
according  to  the  official  occupational  disease  certificate,  he  "  had  been  helping 
store  away  raw  sheepskins,  and  picked  small  pimple  on  side  of  neck."  The 
chief  symptoms  were  "papilla  (small)  on  left  side  of  neck  over  tonsil,  chills. 


68  BULLETIN   OF    THE   BUREAU   OF    LABOR   STATISTICS. 

moderate  fever,  101°-102i° ;  rapid  pulse,  120-140;  edematous  swelling  about 
bead,  neck,  and  chest."  The  swelling  was  "  extremely  rapid,"  and  the  physician 
elsewhere  states  that  "within  24  hours  it  involved  all  the  lymphatics  of  the 
neck  and  axilla."  Anthrax  bacilli  were  found,  but  protective  serum  was  not 
available.  Death  occurred  in  four  days.  The  sheepskins  the  man  handled  were 
imported  from  South  America  and  from  Africa,  and  were  frequently  blood- 
stained. Bloodstained  materials  were  not  eliminated,  and  were  disinfected 
only  by  the  "  tanning  solutions,  lime,  naphthalin,  etc."  The  cleanliness  of  the 
workroom  is  described  as  "  generally  good "  by  the  physician,  who  further 
states  that  hot  water  and  disinfectants  were  furnished  to  the  men,  but  no 
gloves  or  nailbrushes.     The  wife  received  a  small  indemnity. 

No.  59,  of  Brooklyn,  N.  Y.,  died  at  the  age  of  46,  on  April  6,  1913,  of  "  anthrax 
of  the  neck;  fatty  degeneration  of  the  heart."  Deceased  was  a  druggist,  and 
the  physician  who  attended  him  was  unable  to  determine  the  manner  of  con- 
tagion, but  found  anthrax  bacilli  and  a  true  anthrax  pustule.  Treatment  was 
by  "  antiseptic  solution  and  antiseptic  dressing." 

No.  60,  of  Gardner,  Mass.,  died  at  the  age  of  33,  on  April  12,  1913,  of  "  anthrax 
infection  of  face."  The  man  was  a  chair  maker,  and  the  physician  states  that 
he  "  could  find  no  history  of  contact  with  hides,  leather,  wool,  or  animal  mat- 
ter." Nevertheless,  anthrax  bacilli  were  found.  April  5  he  squeezed  a  small 
pimple  on  the  right  side  of  his  lip,  and  it  immediately  began  to  pain  and  swell. 
He  was  seen  by  a  physician  on  April  7,  when  he  had  a  "  congested  pimple  on 
upper  lip  "  and  "  temperature  104°."  Two  days  later  he  returned  to  the  phy- 
sician, with  "  extreme  inflammation  of  side  of  face,  hardened  area  with  car- 
buncle appearance."  The  following  day  he  was  taken  to  a  hospital,  where  he 
died  within  48  hours.    Antianthrax  serum  was  not  available. 

No.  61,  of  Cascade,  Pa.,  died  at  the  age  of  34,  on  May  2,  1913,  of  "  anthrax." 
He  was  a  freight  agent,  and  the  physician  states  that  "  infection  was  caused 
by  handling  foreign  hides." 

No.  62,  of  Racine,  Wis.,  died  at  the  age  of  33,  on  May  5,  1913,  of  "malignant 
pustule  on  face,  also  internal  in  mouth;  edema  of  glottis."  The  woman  was 
a  domestic  servant. 

No.  63,  of  Philadelphia,  Pa.,  died  at  the  age  of  25,  on  May  9,  1913,  of  "  an- 
thrax." The  man  was  a  haircloth  maker.  According  to  a  local  newspaper  he 
felt  ill  after  working  over  "  a  bale  of  hair  from  Siberia,"  and  went  home. 
"  Shortly  afterwards,  apparently  slightly  better,  he  went  for  a  walk  with  his 
wife.  Then  came  a  sudden  seizure  which  laid  him  unconscious  in  the  street." 
A  physician  had  him  sent  to  a  hospital,  but  "  he  died  on  the  way."  The  paper 
further  states  that  the  home  was  placed  under  quarantine.  The  hospital 
physician  describes  the  symptoms  as  "  anthrax  lesion  of  left  cheek." 

No.  64,  of  Wilkes-Barre,  Pa.,  died  at  the  age  of  4  months,  on  May  28,  1913,  of 
"malignant  pustule."  The  physician  states  that  he  was  called  in  on  May  24 
and  found  the  baby  girl  with  a  "  brawny  swelling  about  1  inch  in  diameter 
on  the  left  side  of  the  face  just  above  the  lip."  Thinking  it  was  an  insect  bite 
or  an  ordinary  boil,  he  gave  an  antiseptic  wash,  but  on  calling  the  next  day 
he  found  the  swelling  "  had  extended  up  to  and  was  closing  the  eye,  and  skin 
was  of  a  dark  purple  color ;  fever  quite  pronounced."  The  mother  then  stated 
that  she  suspected  the  infant  had  been  struck  in  the  mouth  with  a  fly  swatter 
by  an  older  child.  The  abscess  grew  until  it  involved  the  whole  left  side  of 
the  face,  and  then  opened  spontaneously.  Large  quantities  of  pus  were  dis- 
charged. The  physician  states  positively  that,  "  while  no  microscopic  exami- 
nation was  made,  the  clinical  symptoms  clearly  pointed  to  infection  by  anthrax 
bacillus." 


ANTHRAX  AS  AN"   OCCUPATIONAL  DISEASE.  69 

No.  65,  of  Hennepin  County,  Minn.,  died  at  the  age  of  16,  on  July  17,  1913,  of 
anthrax.  The  boy  was  the  son  of  a  small  berry  farmer,  and  helped  to  cultivate 
the  berries  and  also  to  care  for  the  cow  and  horse.  The  boy  first  complained 
of  pain  between  the  shoulder  blades,  and  believed  an  insect  had  bitten  him. 
When  he  consulted  a  physician  two  or  three  days  later  the  latter  "  told  him 
it  was  a  big  carbuncle,  as  it  had  all  that  appearance,"  and  ordered  24  hours' 
poulticing.  "  When  he  came  back,"  says  the  doctor,  "  I  opened  it,  making  a 
cross  incision  to  the  bottom  of  it,  then  with  iodized  phenol  thoroughly  cauter- 
ized it  out  and  dressed  it  with  antiseptic  gauze."  Three  days  afterwards  the 
boy  came  back,  "  having  considerable  temperature  "  and  "  more  pain."  The 
lesion  was  curetted  out,  cauterized  again,  and  then  dressed  twice  daily,  but 
"  the  malignancy  kept  spreading,  delirium  developed,  as  well  as  all  the  marked 
symptoms  of  blood  poisoning."  A  consultant  was  called,  who  pronounced  the 
case  anthrax.  "  No  matter  how  thoroughly  the  gangrenous  parts  were  cleaned 
out  and  strong  antiseptics  used,  it  kept  extending.  Temperature  kept  going 
up  until  it  reached  107°."  No  laboratory  examination  was  made,  but  the 
attending  practitioner  states  that  the  case  "  was  pronounced  anthrax  by  two 
physicians." 

No.  66,  of  North  Attleboro,  Mass.,  died  at  the  age  of  76,  on  July  20,  1913,  of 
"  malignant  pustule."  She  had  been  acting  as  housekeeper  and  nurse  for  one 
of  her  daughters  in  a  neighboring  town  who,  according  to  her  own  family 
physician,  died  of  puerperal  sepsis.  While  so  engaged  the  woman  "  scratched 
her  finger  on  a  nail  in  cellar  stairway,"  and  was  seized  with  "  chills  "  and 
"  high  fever."  Two  days  after  returning  to  her  own  home  the  woman  called 
a  physician,  who  found  her  arm  swollen  and  "  of  dark  purple,"  fever  104°. 
"  Next  morning  small  pustules  appeared  on  the  whole  extent  of  limb,  and 
glands  of  axilla  appeared  to  be  a  whole  solid  mass."  General  treatment  was 
administered  to  reduce  the  fever,  three  incisions  were  made  the  entire  length 
of  the  arm,  and  a  wet  bichloride  of  mercury  dressing  (1  to  3,000)  was  applied. 
Death  occurred  on  the  fourth  day  of  treatment.  The  physician  states  that  in 
his  opinion  "  infection  was  due  to  inoculation  with  bacillus  anthracis." 

No.  67,  of  Windsor  Locks,  Conn.,  died  at  the  age  of  49,  on  August  5,  1913,  of 
"  malignant  pustule ;  septicemia."  He  was  a  liveryman  and  the  physician 
states  that  "  it  has  never  been  cleared  whether  the  case  was  anthrax  from  the 
start,  or  if  the  patient  was  inoculated  with  the  disease  subsequently  when,  at 
his  request,  the  small  pustule  was  opened  with  a  penknife  in  the  hands  of  a 
relative."  The  knife  had  previously  been  used  by  the  patient  in  incising  what 
he  thought  was  an  "  abscess  "  on  one  of  his  horses,  but  had  disappeared  before 
the  reporting  physician  took  charge  of  the  case.  The  disease  lasted  five  days, 
appearing  as  "  pustule  on  upper  lip,  profound  toxemia  from  start."  Bac- 
teriological examination  was  not  complete,  but  antianthrax  serum  was  injected. 
Local  treatment  was  by  incision,  drainage,  and  antiseptic  applications. 

No.  68,  of  Brighton,  Pa.,  died  at  the  age  of  34,  on  August  13,  1913,  of  "  an- 
thrax." She  was  a  housewife,  and  the  physician  states  that  the  "  symptoms 
convinced  him  as  to  bacillus  anthracis." 

No.  69,  of  Wilmington,  Del.,  died  at  the  age  of  54,  on  August  23,  1913,  of 
"  anthrax."    He  was  employed  by  a  large  morocco  plant. 

No.  70,  of  Lincoln,  Mo.,  died  at  the  age  of  28  on  September  8,  1913,  of  "  an- 
thrax ;  metastatic  pneumonia."  Deceased  was  "  a  robust,  rugged  young  farmer." 
On  September  3  the  physician  who  was  called  to  examine  him  found  "  a  large 
vesicle  at  the  seat  of  infection  "  on  the  septum  of  the  nose,  and  "  several  small 
vesicles  on  the  external  part  of  the  nose."  The  disease  had  then  been  progress- 
ing two  or  three  days,  and  the  whole  nose  was  "  of  a  very  dark  color  and  badly 


70  BULLETIN    OF    THE    BUKEAU    OF    LABOE    STATISTICS. 

swollen  "  and  one  eye  was  "  swelled  shut."  The  nose  was  gangrenous  in  appear- 
ance, "  and  also  in  fact,  as  when  I  cut  the  nose  with  my  knife  he  did  not  have 
any  painful  sensations."  Temperature  at  the  first  visit  was  99°,  pulse  90,  "  and 
not  a  great  deal  of  constitutional  disturbance."  On  September  4  there  was  little 
change,  "  except  that  the  gangrenous  condition  had  extended  to  the  left  cheek." 
The  following  day,  however,  "  he  had  a  severe  pain  in  the  left  side,  temperature 
101°,  dullness  on  percussion  over  the  lower  lobe  of  left  lung,  bloody  expectora- 
tion, crepitant  rales  on  auscultation,  and  a  further  extension  of  the  gangrenous 
condition  of  the  face."  On  the  6th  there  was  less  pain  in  the  side,  but  the 
gangrenous  condition  on  the  face  was  "  still  spreading."  By  the  7th  the  right 
lung  had  become  involved,  there  was  "  considerable  difficulty  of  breathing,  pulse 
rate  greatly  increased  in  frequency ;  gangrenous  condition  at  this  time  extended 
below  the  angle  of  the  jaw."  On  September  8  all  the  symptoms  had  become  more 
severe,  and  when  last  seen  by  the  physician  he  was  "  going  into  a  state  of 
collapse  and  died  in  a  short  time.  Anything  I  did  for  him  did  not  check  the 
progress  of  the  disease  in  the  least,  and  had  he  not  been  of  a  very  robust  consti- 
tution would  have  died  sooner  than  he  did."  None  of  the  pathological  specimens 
were  examined  microscopically,  but  from  the  clinical  symptoms  the  doctor  has 
no  doubt  that  he  had  "  to  deal  with  a  very  severe  case  of  anthrax." 

No.  71,  of  Gates,  N.  Y.,  died  at  the  age  of  16,  on  September  29,  1913,  of  "  splenic 
fever ;  malignant  facial  anthrax."  The  physician  states  that  the  boy  "  chored 
around  home,"  and  that  the  source  of  the  infection  is  unknown.  "  Pustule 
appeared  on  lower  lip,  spread  rapidly  over  whole  left  side  of  face ;  chills,  enlarge- 
ment of  spleen,  high  fever,  gastroenteric  hemorrhages  and  meningitis ;  died 
in  coma." 

No.  72,  of  Elyria,  Ohio,  died  at  the  age  of  67,  on  October  7,  1913,  of  "  anthrax ; 
chronic  nephritis."    He  was  a  physician. 

No.  73,  of  Unity,  Pa.,  died  at  the  age  of  1,  on  October  22,  1913,  of  "  cholera 
infantum  and  anthrax."  The  physician  states  that  the  child,  a  girl,  was  ill  about 
three  weeks.  He  did  not  think  it  necessary  to  make  a  microscopic  examination, 
but  is  certain  case  "  was  due  to  inoculation  with  bacillus  anthracis."  Protective 
serum  was  not  available.  The  family,  he  declares,  was  "  very  unclean,  and  child 
could  have  contracted  the  disease  by  toying  with  a  diseased  dog  or  cat,  or  from 
partaking  of  milk  or  butter,  or  through  the  agency  of  flies  or  insects,  or  by 
inhaling  dust  containing  the  virus." 

No.  74,  of  -Elkland,  Pa.,  died  at  the  age  of  52,  on  October  23,  1913,  of 
"  anthrax ;  infection  upon  the  neck."  He  handled  hides  in  a  tannery,  re- 
ceiving $2  a  day.  The  hides  were  imported  from  South  America  and  China. 
Bloodstained  materials  were  not  eliminated  at  the  plant,  the  physician  says, 
and  he  does  not  think  disinfection  was  carried  on  or  that  gloves  or  nail- 
brushes were  furnished.  The  man  sought  medical  assistance  only  when 
it  was  "  too  late  for  human  aid."  He  was  taken  to  Lycoming  County.  Anti- 
anthrax  serum  was  obtained  in  Philadelphia  and  freely  used,  but  the  disease 
had  already  progressed  too  far,  and  he  died  on  the  sixth  day  of  the  attack. 
The  company  paid  the  funeral  expenses  and  offered  the  widow  $500  in  settle- 
ment, which  she  refused.  The  lawyer  in  whose  hands  she  put  the  case  secured 
a  judgment  for  $300,  out  of  which'  he  charged  a  $90  fee.  Apparently  the  suit 
dragged  until  the  beginning  of  1916,  for  the  widow  states  that  "  they  are  now 
paying  me  $10  per  month  "  since  January  1  of  that  year. 

No.  75,  of  Hanford,  Gal.,  died  at  the  age  of  33,  on  November  11,  1913,  of 
"  anthrax."  He  was  a  ranch  laborer,  earning  $2  a  day.  First  symptoms 
appeared  on  November  6,  but  a  physician  was  not  called  until  the  9th.  At 
that  time,  says  the  latter,  "  the  face  was  swollen  on  right  side  over  antrum 


ANTHRAX    AS   AX    OCCUPATIONAL   DISEASE.  71 


and  was  quite  tender  to  pressure.  Tenderness  on  canine  and  biscuspid  teeth 
was  shown  when  pressure  was  made.  Eyelid  edematous  and  red.  Diagnosis 
at  that  time  was  made  as  abscess  of  antrum,  and  operation  for  draining  was 
advised."  The  same  evening  the  floor  of  the  antrum  was  perforated  under 
ether  "  and  a  dark,  bloody  discharge  escaped."  The  patient  regained  con- 
sciousness, but  the  next  morning  the  swelling  had  greatly  increased  on  right 
side,  closing  the  eye  and  assuming  a  dark  purplish  hue.  The  left  side  of  the 
face  became  involved.  Bloody  secretions  drained  from  nose  on  right  side  and 
from  opening  draining  the  antrum.  "  A  peculiar  odor  from  the  patient  caused 
me  to  associate  it  with  the  odor  I  had  noted  in  a  cow  dying  from  anthrax. 
Specimens  taken  from  secretions  of  nose  and  antrum  each  showed  the  anthrax 
bacillus  in  large  numbers.  At  noon  on  the  10th  the  patient  became  uncon- 
scious. Patient  died  at  3  o'clock  on  the  afternoon  of  the  11th."  Death  oc- 
curred in  a  sanatorium. 

No.  76,  of  Boston,  Mass.,  died  at  the  age  of  23,  on  December  13,  1913,  of 
"  anthrax ;  toxemia."  Deceased  was  a  longshoreman.  From  the  hospital 
record  it  is  learned  that  two  weeks  before  admission  he  "  handled  South  Ameri- 
can hides,"  and  three  days  before  admission  he  "  handled  American  hides." 
Four  days  before  he  entered  the  hospital  a  "  pimple  appeared  on  his  right  neck 
below  the  angle  of  the  jaw.  Several  blebs  appeared  later  around  the  pimple 
which  broke  down.  Pain  and  swelling  with  redness  and  induration  followed." 
At  the  time  of  admission  the  patient  presented  "  a  small  brown  ulcer  on  right 
side  of  neck  one-third  inch  in  diameter,  surrounded  by  a  circle  of  white  blebs 
near  by.  Considerable  edema  of  whole  right  side  of  neck  extending  as  far 
forward  as  point  of  jaw ;  temperature,  102°  ;  white  blood  count,  32,400."  A 
circular  excision  was  made  and  swabbed  out  with  iodine;  forced  nourishment 
and  stimulants  were  given;  corrosive  1/5,000  dressing  every  four  hours. 
Blood  culture  was  positive  for  anthrax  bacillus.  "Edema  soon  extended  down 
whole  right  side  of  chest,  turning  a  dusky  red.  Patient  failed  gradually  since 
operation,"  though  suffering  little  pain.  Finally  he  "  became  delirious  and  in  a 
few  hours  sank  into  coma  and  died."  The  deceased  left  a  dependent  mother, 
but  indemnity,  which  xinder  the  Massachusetts  workmen's  compensation  law  is 
paid  for  cases  of  anthrax,  was  refused  in  this  case,  because  the  insurance  com- 
pany contended  that  the  disease  was  not  contracted  while  the  deceased  was 
in  the  employ  of  their  policyholder,  but  while  working  for  another  company. 

No.  77,  of  Winchester,  Va.,  died  at  the  age  of  46,  on  December  20,  1913,  of 
"  blood  poisoning,  the  result  of  anthrax."    He  was  a  barber. 

No.  78,  of  Union,  N.  Y.,  died  at  the  age  of  56,  on  December  24,  1913,  of 
"  anthrax  infection."  The  disease  took  the  form  of  "  anthrax  edema " ;  it 
"  developed  on  the  face ;  advance  was  very  rapid  to  extensive  involvement  of 
face,  head,  and  neck  " ;  diagnosis  was  made  on  the  third  day  and  was  con- 
firmed by  the  State  laboratories.  The  deceased  was  a  farmer,  and,  according 
to  the  physician,  "  was  in  the  habit  of  buying  up  old  and  poorly  nourished  cat- 
tle, butchering  them,  and  selling  them  where  he  could.  He  certainly  handled 
diseased  meat."  At  the  time  of  his  death  he  was  awaiting  trial  for  selling 
tuberculous  meat.  "  The  hired  man,"  continues  the  doctor,  "  says  he  has  gone 
home  at  night  leaving  a  very  sick  cow  in  the  stable  and  found  in  the  morning 
a  beef  dressed  and  the  sick  animal  missing.  No  questions  were  asked  or 
answered  in  regard  to  it."  It  therefore  seems  to  the  physician  "likely  that 
infection  took  place  during,  or  as  a  result  of,  his  occupation  as  a  handler  of 
domestic  beef,  and  that  often  diseased." 

No.  79,  of  South  Windsor,  Conn.,  died  at  the  age  of  14,  on  January  16,  1914, 
of  "anthrax  or  malignant  pustule;  toxemia."  The  girl  had  no  occupation. 
The  illness  lasted  10  days. 


72  BULLETIN   OF   THE  BUREAU   OF   LABOR  STATISTICS, 

No.  80,  of  Camden,  N.  J.,  died  at  the  age  of  47,  on  January  29,  1914,  of 
"anthrax  (malignant  pustule)."  He  had  been  employed  for  eight  months 
as  a  checker  and  receiver  of  horse  hides  imported  from  Russia  in  an  estab- 
lishment where  leather  was  tanned  and  finished.  Diagnosis  was  made  on  the 
second  day  of  the  illness.  The  pustule  was  located  under  the  right  ear.  The 
physician  also  found  edema  of  upper  chest,  rapid  pulse,  cold  extremities,  no 
pain,  and  no  complicating  conditions.  Serum  treatment  was  used,  but  with 
no  improvement.  The  illness  lasted  four  days.  Previous  to  entering  the  occu- 
pation which  caused  his  death  he  had  been  an  undertaker. 

No.  81,  of  Fremont,  Ohio,  died  at  the  age  of  52,  on  March  9,  1914,  of  "  rheu- 
matism and  anthrax;  pericarditis."  According  to  the  official  death  certificate 
the  illness  lasted  three  months.    The  occupation  of  the  patient  is  not  stated. 

No.  82,  of  Philadelphia,  Pa.,  died  at  the  age  of  30,  on  March  15,  1914,  of 
"  anthrax."  "  Anthrax  bacillus  was  proved  by  finding  the  organism  in  the 
discharge  from  his  cervical  lesion."  The  man  was  colored  and  worked  as  a 
stevedore,  and  three  days  before  his  death  he  had  been  "unloading  a  cargo 
of  hair  from  China."  The  physician  who  examined  him  at  the  hospital  "  found 
a  diffuse  swelling  of  the  right  cervical  region,  with  evidence  of  a  small  pustule 
which  had  ruptured  and  was  rather  inconspicuous  because  of  the  dark  surface 
of  the  skin.  The  case  was  not  diagnosed  at  the  time  as  one  of  malignant 
pustule,  and  an  incision  for  the  purpose  of  drainage  was  made  in  the  neck." 
The  patient  came  to  the  hospital  next  day,  and  a  number  of  incisions  were 
made  on  his  neck  for  the  purpose  of  relieving  his  respiratory  difficulty.  "He 
grew  progressively  worse,  and  died  in  the  hospital  ward  60  hours  from 
the  time  he  applied  for  treatment.  Our  cultures  showed  the  anthrax  bacillus 
in  both  cultures." 

No.  83,  of  Pleasant  Prairie,  Wis.,  died  at  the  age  of  55,  on  March  20, 
1914,  of  "  anthrax,  general  infection."  He  was  a  farmer.  Physician  states 
that  the  man  opened  a  cow  to  ascertain  the  cause  of  its  death  and  found 
in  its  abdomen  black  spots,  which  he  dissected.  The  "  pubic  region  and  limbs  " 
were  affected.  Examination  showed  "  various  necrotic  areas  which  rapidly 
broke  down.  Scrotum  very  much  enlarged  and  necrotic."  Patient  was  de- 
lirious for  two  days.    The  illness  lasted  seven  days. 

No.  84,  of  Calexico,  Cal.,  died  at  the  age  of  70,  on  April  6,  1914,  of  "  sep- 
ticemia, almost  certainly  due  to  anthrax  in  a  cow;  died  of  it  a  few  days 
ago."    The  illness  lasted  five  days.    The  patient  was  a  housewife. 

No.  85,  of  Philadelphia,  Pa.,  died  at  the  age  of  38,  on  April  6,  1914,  of  "an- 
thrax."    She  was  a  housewife. 

No.  86,  of  Norfolk,  Va.,  died  at  the  age  of  54,  on  April  11,  1914,  of  "  anthrax 
(malignant  edema)  ;  toxemia."     Illness  lasted  five  days. 

No.  87,  of  Philadelphia,  Pa.,  died  at  the  age  of  60,  on  May  6,  1914,  of 
"  anthrax."  He  was  a  skin  washer  in  a  leather  factory.  Illness  lasted  four 
days.  The  physician  at  the  hospital  where  he  was  admitted  on  the  third  day 
of  the  disease  describes  the  attack  as  "  anthrax  lesion  on  left  side  of  face." 

No.  88,  of  New  Orleans,  La.,  died  at  the  age  of  3  months,  on  May  29,  1914,  of 
"  anthrax  at  base  of  spine ;  scrofula."    He  was  ill  one  month. 

No.  89,  of  Philadelphia,  Pa.,  died  at  the  age  of  35,  on  June  17,  1914,  of 
"  anthrax."  The  patient  was  colored ;  he  worked  as  a  longshoreman,  and  three 
days  previous  to  admission  to  the  hospital  where  he  died  he  was  unloading 
hides.  "  Two  days  after  that,"  writes  the  physician,  "  a  pimple  on  the  face 
began  to  swell  rapidly,  causing  little  pain.  The  swelling  progressed  and 
involved  all  the  tissues  of  the  neck.  Anthrax  serum  was  not  used  in  the 
treatment." 


ANTHRAX   AS  AN    OCCUPATIONAL  DISEASE.  73 

No.  90,  of  Cincinnati,  Ohio,  died  at  the  age  of  41,  on  August  8,  1914,  of 
"  anthrax  infection  of  face ;  acute  nephritis."  He  was  a  tailor  and  presser. 
He  became  sick  on  August  2 ;  the  first  symptom  "  appeared  on  the  upper  lip, 
where  a  horsefly  bit  him  while  out  in  the  country.  Entire  face  swelled  up  and 
was  somewhat  red  and  edematous.  Both  eyes  were  closed  from  extensive 
swelling." 

No.  91,  of  Lewiston,  Me.,  died  at  the  age  of  45  years,  on  August  19,  1914,  of 
"  endocarditis,  with  chronic  rheumatism  and  anthrax."  His  occupation  was 
given  by  the  official  certificate  as  laborer,  and  the  physician  states  that  his 
average  earnings  were  $1.75  a  day.  The  attack  is  described  as  "  cauliflower 
on  the  back  of  the  neck."  The  treatment  given  was  "  cruciform  opening  and 
burning  with  cautery."     Serum  was  not  used. 

No.  92,  of  Hollidaysburg,  Pa.,  died  at  the  age  of  18  years,  on  September  10, 
1914,  of  "  malignant  pustule."     She  had  no  occupation. 

No.  93,  of  Wilmington,  Del.,  died  at  the  age  of  29,  on  October  10,  1914,  of 
"  anthrax ;  edema  of  larynx."    He  was  a  morocco  worker. 

No.  94,  of  Brooklyn,  N.  Y.,  died  at  the  age  of  56,  on  November  25,  1914,  of 
"  anthrax ;  infection  bacillus  anthracis."  The  official  death  certificate  desig- 
nated him  merely  as  "  laborer,"  but  from  other  sources  it  was  learned  that  he 
worked  in  a  tannery.  "  Two  days  before  admission  to  the  hospital  patient 
noticed  a  small  pimple  on  neck ;  he  said  he  pinched  it ;  from  that  time  on  the 
neck  became  more  and  more  swollen.  At  first  there  was  little  pain,  but  a  diffi- 
culty in  breathing  developed  just  hefore  admission."  In  the  hospital  "  excision 
of  pustule  and  incisions  of  indurated  area  "  were  made.  The  patient  died  four 
days  later.    Anthrax  bacilli  were  "  recovered  from  all  organs." 

No.  95,  of  Smithson,  Pa.,  died  at  the  age  of  42,  on  December  8,  1914,  of 
"  anthrax."  He  was  a  liveryman.  He  was  two  days  at  a  hospital  in 
McKeesport,  Pa. 

No.  96,  of  Lincoln,  Nebr.,  died  at  the  age  of  39,  on  December  8,  1914,  of 
"  septic  infection  due  to  anthrax  bacillus."  Her  occupation  was  given  as  house- 
wife.   She  was  ill  one  month. 

No.  97,  of  Camden,  N.  J.,  died  at  the  age  of  53,  on  December  31,  1914,  of 
"  anthrax."  He  was  a  laborer  in  a  morocco  factory.  The  physician,  when 
called  in,  found  the  patient  dying.  Examination  disclosed  "  external  anthrax, 
malignant,  pustule,  high  fever,  edema  of  glands  and  surrounding  parts."  The 
illness  lasted  five  days. 

No.  98,  of  Fort  Morgan,  Colo.,  died  at  the  age  of  1,  on  March  29,  1915,  of  "  an- 
thrax ;  measles."  The  child,  according  to  the  physician,  was  scratched  on  the  leg 
by  the  teeth  of  a  small  dog  with  which  he  was  playing.  The  parents  attached  no 
importance  to  the  incident,  and  did  not  even  wash  or  cauterize  the  scratch.  Two 
or  three  days  later,  the  child  was  taken,  with  a  badly  swollen  leg,  to  the  phy- 
sician, who  discovered  that  a  calf  had  died  of  anthrax  on  the  farm  and  that 
the  dog  had  been  getting  his  meals  from  the  carcass,  which  had  not  been 
burned  or  buried.  "  The  child  was  very  ill  when  I  saw  it  first.  No  serum  was 
available  when  I  recognized  the  cause  of  infection.  The  temperature  was 
high.  The  secretion  from  the  limb  was  bloody.  No  pus.  The  swelling  con- 
tinued to  increase  and  extended  upward  to  the  abdomen.  The  leg  was  kept  in 
a  wet  dressing  of  bichloride,  while  stimulants  were  given  internally."  A  cul- 
ture in  blood  serum  was  made  and  "  a  pure  culture  of  anthrax "  resulted. 
The  child  was  ill  two  weeks. 

No.  99,  of  Dos  Palos,  Cal.,  died  at  the  age  of  25,  on  April  3,  1915,  of  "  anthrax ; 
due  to  bacillus  anthracis."  He  was  a  farm  laborer,  and  at  the  time  of  the  at- 
tack he  handled  cattle  and  cattle  hides  of  local  origin.    "  Patient  was  taken  sick 


74  BULLETIN   OF    THE   BUREAU   OF    LABOR   STATISTICS. 

about  March  21,  1915,"  writes  the  physician  of  a  hospital  in  Fresno  where  the 
man  was  taken  for  treatment.  "At  this  time  he  was  treated  by  a  doctor  who 
made  the  diagnosis  of  pleurisy  with  rheumatism.  At  the  onset  he  had  severe 
pain  in  the  left  side  with  several  chills.  This  was  shortly  followed  by  a 
swelling  of  the  right  ankle,  which  was  quite  tender  and  painful.  Patient 
came  under  our  care  on  March  28,  1915."  In  the  hospital  his  case  was  diagnosed 
as  "  pulmonary  anthrax,  with  general  blood  infection."  Local  treatment  was 
applied  to  the  pustules,  which  were  situated  on  the  lower  eyelid  and  on  the 
anterior  surface  of  the  thigh,  and  smears  from  both  lesions  showed  anthrax 
bacilli.  On  April  1,  40  cubic  centimeters  of  antianthrax  serum  were  injected 
intravenously ;  on  the  following  day  a  dose  of  60  cubic  centimeters  was  given. 
"  This  is  all  the  antianthrax  serum  we  were  able  to  secure  on  the  coast," 
writes  the  hospital  physician.  The  patient  died  on  the  thirteenth  day  of  his 
illness. 

No.  100,  of  Hartford  City,  Ind.,  died  at  the  age  of  69,  on  April  4,  1915,  of 
"  malignant  anthrax."  He  was  a  merchant.  The  physician  in  charge  stated 
that  this  was  a  case  of  "  infectious  febrile  disease  due  to  the  inoculation  into 
the  hand  of  the  anthrax  bacillus.  Death  being  due  to  obstruction  of  circula- 
tion by  these  bacilli ;  much  subcutaneous  edema  near  the  inoculation  wound, 
and  also  metastatic  lesions." 

No.  101,  of  Williamsport,  Pa.,  died  at  the  age  of  53,  on  April  25,  1915,  of 
"  anthrax  causing  edema  of  larynx ;  facial  anthrax."  Occupation  is  given 
merely  as  "  laborer." 

No.  102,  of  Coudersport,  Pa.,  died  at  the  age  of  31,  on  May  12,  1915,  of  "  in- 
ternal anthrax ;  typical  case  true  anthrax."    His  occupation  is  given  as  laborer. 

No.  103,  of  Coudersport,  Pa.,  died  at  the  age  of  29,  on  May  18,  1915,  of  "  septic 
infection ;  typical  case  true  anthrax."  For  several  years  he  had  been  em- 
ployed at  about  $1.60  per  day  as  a  laborer  in  a  tannery,  where  sole  leather  was 
made.  He  came  in  contact  with  imported  dried  hides.  According  to  the 
physician  in  charge  of  the  case,  no  sanitary  precautions  were  taken.  Not  all 
the  hides  were  disinfected;  there  was  no  special  ventilation;  the  workrooms 
were  very  dirty.  The  disease  took  the  form  of  a  pustule  on  the  neck.  At  the 
hospital,  where  the  patient  was  taken,  excision  was  performed  and  carbolic  acid 
was  injected  around  the  affected  area.  Serum  was  not  available;  the  illness 
lasted  six  days. 

No.  104,  of  Nunda,  N.  Y.,  died  at  the  age  of  14,  on  May  24,  1915,  of  "  septi- 
cemia ;  anthrax  of  back."  Physician  says  "  all  symptoms  point  to  true  an- 
thrax." The  disease  was  not  suspected  until  three  days  before  the  boy's  death, 
when  diagnosis  was  made.  The  patient  had  high  fever  and  delirium,  and  the 
disease  developed  rapidly.  The  boy  was  attending  school  and  choring  about 
the  house. 

No.  105,  of  Endicott,  N.  Y.,  died  at  the  age  of  22,  on  June  1,  1915,  of  "  septi- 
cemia ;  anthrax."  The  deceased  was  employed  in  a  leather  factory  unloading 
dry  South  American  and  Chinese  hides.  They  were  said  to  have  been  disin- 
fected. Examination  showed  "  infection  on  arm  and  neck,  and  swollen  chest." 
The  hospital  physician  states  that  he  "  injected  with  12  per  cent  carbolic  acid 
and  removed  infected  area."  No  serum  was  given.  The  illness  lasted  two  days. 
"  Positive  diagnosis  was  made  after  death  by  bacteriological  test  of  blood  and 
tissue  of  arm." . 

No.  106,  of  Thompsonville,  Conn.,  died  at  the  age  of  35,  on  June  7,  1915,  of 
"  anthrax  infection ;  genuine  anthrax ;  from  initial  ulceration  on  neck."  The 
anthrax  organism  was  "diagnosed  in  smear  and  culture."  He  was  employed  in 
a  carpet  factory.    The  physician  at  the  Hartford  hospital,  where  the  patient 


ANTHRAX   AS  AN    OCCUPATIONAL  DISEASE.  75 

was  taken,  states  that  there  was  a  "pustule  on  anterior  neck,  and  edema  and 
cyanosis  of  anterior  chest."  Serum  was  not  available.  The  illness  lasted  six 
days. 

No.  107,  of  Brooklyn,  N.  Y.,  died  at  the  age  of  6,  on  June  29,  1915,  of  "  general 
asthenia  from  anthrax  infection  of  nose."  "  An  infectious  febrile  disease  with 
local  symptoms,"  says  the  physician,  "  manifested  itself  in  nose  and  its  accessory 
and  other  sinuses ;  the  discharge  showed  a  bacillus  having  all  the  characteristics 
of  the  bacillus  anthracis."    The  child's  illness  lasted  15  days. 

No.  108,  of  Charlestown,  Mass.,  died  at  the  age  of  50,  on  July  4,  1915,  of 
"anthrax."  Autopsy  showed  that  "he  suffered  from  anthrax  septicemia,  with 
associated  leptomeningitis  and  hydrothorax."  He  was  a  longshoreman.  "  In- 
vestigation brought  out,"  states  the  physician  of  the  Boston  hospital  where  the 
man  died,  "  that  on  May  25,  1915,  he  worked  in  the  hold  of  a  vessel  laden  with 
dried  blood,  ground  bones,  and  phosphate,  and  subsequently  to  that  date  assisted 
in  the  discharging  of  dried  hides." 

No.  109,  of  New  Orleans,  La.,  died  at  the  age  of  23,  on  July  8,  1915,  of 
"  acute  nephritis ;  edema  of  lungs ;  bacillus  anthracis ;  septicemia."  He  was  a 
laborer. 

No.  110,  of  Boston,  Mass.,  died  at  the  age  of  38,  on  July  8,  1915,  of  "  anthrax ; 
neck  infection  with  bacillus  anthracis."  He  was  unloading  dry  hides  at  the 
wharves.  The  physician  at  the  hospital  where  the  patient  was  admitted  on  the 
day  before  his  death  describes  his  disease  as  "  septicemia  with  brawny  swelling 
of  right  face  and  neck  and  bulla  formation.  No  local  carbuncle.  Blood  cultures 
were  positive." 

No.  Ill,  of  New  York  City,  died  at  the  age  of  34,  on  July  29, 1915,  of  "  anthrax 
infection  of  neck."  He  was  a  weigher  in  the  United  States  customhouse  and 
handled  skins  and  hides  from  South  America.  His  duty  was  to  tear  open  bales 
to  inspect  and  weigh  their  contents.  Not  all  the  materials  he  handled  were 
disinfected,  and  no  care  was  taken  to  prevent  danger.  He  had  been  in  the 
work  since  1908  and  was  earning  on  the  average  $4.50  a  day.  The  physician 
to  whom  he  applied  for  treatment  performed  "  excision  of  lesion  and  drainage."' 
No  serum  was  used.  The  illness  lasted  five  days.  A  portion  of  the  excised 
tissue  was  sent  for  examination  to  the  research  laboratory  of  the  New  York 
City  Department  of  Health,  which  reported  :  "  Microscopic  examination  of  gland 
removed  from  neck  shows  anthrax  bacillus  in  culture  and  liver  of  dead  injected 
mice."  The  physician  considered  the  case  particularly  pathetic  because  the 
widow  was  "  left  without  means  and  with  three  small  children,"  and  since  the 
Federal  Workmen's  Compensation  Act  of  1908  does  not  cover  the  employees  of 
the  customhouse,  the  physician's  efforts  to  obtain  a  pension  from  the  United 
States  Government  for  the  widow  were  unsuccessful,  as  "there  appears  to  be  no 
provision  for  such  cases.  It  would  seem  that  the  Government  should  make  some 
provision  for  the  ones  left  dependent  through  its  employment  of  workers  at 
occupations  likely  to  cause  their  death."  A  special  bill  for  the  relief  of  this 
family  was  finally  introduced  in  Congress,  almost  a  year  after  the  man's  death, 
but  up  to  the  time  this  report  was  written  the  House  Committee  on  Claims,  to 
which  the  bill  was  referred,  had  taken  no  action  on  it. 

No.  112,  of  Bountiful,  Utah,  died  at  the  age  of  65,  on  August  24,  1915,  of 
"  anthrax."  Death  occurred  in  the  farmers'  ward  of  the  county  hospital  at  Salt 
Lake  City,  after  three  days'  treatment.     The  man  was  a  carpenter. 

No.  113,  of  Baltimore,  Md.,  died  at  the  age  of  20,  on  August  30,  1915,  of  "  Etas 
tula  maligna  on  under  lip;  pyemia;  anthrax."  The  victim  had  do  employment ; 
she  lived  at  home  with  her  parents  and  at  the  time  of  her  illness  was  visiting 


76  BULLETIN"   OF    THE   BUREAU   OF    LABOR  STATISTICS. 

New  York.  The  first  symptoms  appeared  about  August  18.  The  young  woman 
"had  a  pimple  on  her  lower  lip  and,  as  it  annoyed  her,  she  pricked  it  with  a 
needle.  It  steadily  grew  worse,"  and  she  went  to  a  hospital  across  the  street. 
There  she  was  treated  as  an  outpatient  for  a  few  days.  The  diagnosis  of  an- 
thrax was  made  on  August  25,  and  then  "  injections  of  iodine  and  other  germi- 
cides ".  were  made  and  "  constitutional  treatment  internally  "  was  given.  Serum 
was  "  not  obtainable.  The  pus  filtration  was  very  rapid  and  spread  to  the 
right  cheek  and  neck  alarmingly."  The  physician  was  unable  to  find  out  to 
what  uses  the  needle  had  been  put  with  which  the  patient  pricked  the  pimple 
on  her  lip. 

No.  114,  of  New  London,  Conn.,  died  at  the  age  of  57,  on  September  3,  1915, 
of  "malignant  pustule;  convulsions."    His  occupation  is  given  as  printer. 

No.  115,  of  Brentwood,  N.  Y.,  died  at  the  age  of  23,  on  September  29,  1915, 
of  "  malignant  anthrax  edema."  She  was  a  clerk  in  the  post  office.  The  hospital 
physician  who  attended  the  case  diagnosed  it  as  "  infection  with  bacillus 
anthracis,  which  bacillus  was  recovered  from  the  excised  papule  at  the  New 
York  City  research  laboratory.  The  source  of  this  infection,  which  was  on 
the  side  of  the  neck,  was  not  determined."  The  physician  states,  however, 
that  the  young  woman  had  "  tried  on  clothing  trimmed  with  fur  at  various 
department  stores  in  New  York  City."  The  disease  took  the  form  of  malignant 
edema,  "  without  pustule  except  fleabitelike  papule."  Curative  seriuin  was  se- 
cured from  Philadelphia,  after  unsuccessful  efforts  to  obtain  it  in  New  York, 
and  injected  both  subcutaneously  and  intravenously.  Supportive  treatment  was 
also  given,  but  death  occurred  on  the  sixth  day. 

No.  116,  of  New  York  City,  died  at  the  age  of  52,  on  October  7,  1915,  of 
"  anthrax."  The  first  symptom  was  an  "  itching  sensation  on  chest."  Examina- 
tion by  the  hospital  physician  disclosed  "papule  on  chest,  with  spreading  in- 
flammation over  left  side  of  body.  Fever  and  prostration.  Both  microscopical 
examination  and  autopsy  proved  case  to  be  due  to  bacillus  anthracis."  The 
patient  had  been  working  for  five  years  as  a  laborer  and  driver  and  during 
the  week  before  illness  was  unloading  hides  from  a  vessel.  He  was  ill  four 
days;  diagnosis  was  made  on  the  day  preceding  his  death.  No  serum  was 
available. 

No.  117,  of  Madison,  N.  Y.,  died  at  the  age  of  52,  on  October  12,  1915,  of 
"poison  from  anthrax;  cardiac  paralysis."  His  occupation  is  not  given  on 
the  official,  certificate.  The  physician  stated  that  death  was  due  to  "  true 
anthrax;  fever  and  involvement  of  the  glands." 

No.  118,  of  Riverhead,  N.  Y.,  died  at  the  age  of  71,  on  October  15,  1915,  of 
"  anthrax."  The  patient  was  a  retired  lawyer  and  did  no  work  except  caring 
for  his  own  home.  The  manner  of  infection  was  a  puzzle  to  the  physicians,  as 
he  came  in  contact  neither  with  nondisinfected  material  nor  with  animals.  The 
man  was  never  ill  before.  On  October  8  he  first  noticed  on  his  face  a  small 
lump,  which  soon  became  a  red  itching  spot.  The  disease  spread  rapidly  over 
his  face,  it  reached  the  chin  and  attacked  the  glands  of  the  neck.  On  the  fol- 
lowing day  he  was  taken  to  the  hospital  and  the  disease  was  diagnosed  as 
anthrax ;  130  c.c.  of  Eichorn's  serum  were  injected  during  the  period  of  three 
days,  but  without  avail.     Anthrax  bacilli  were  demonstrated. 

No.  119,  of  Blue  Earth  County,  Minn.,  died  at  the  age  of  35,  on  October  22, 
"J915,  of  "  external  and  internal  anthrax."  The  physician's  statement  gives 
•'  diagnosis  of  inoculation  with  bacillus  anthracis."  The  patient  was  a  house- 
wife.    Her  illness  lasted  12  days. 

No.  120,  of  Bainbridge,  N.  Y..  died  at  the  age  of  24,  on  November  12,  1915,  of 
''septicemia;  probably  anthrax  bacillus."     The  deceased  was  helping  on  her 


ANTHRAX  AS  AN   OCCUPATIONAL   DISEASE.  77 

father's  dairy  farm  doing  housework  and  milking.  The  disease  was  diagnosed 
as  anthrax  by  two  physicians  who  had  seen  cases  before.  The  illness  lasted 
10  days.     Serum  was  not  available. 

No.  121,  of  New  York  City,  died  at  the  age  of  17,  on  November  18,  1915,  of 
"  anthrax."  The  cause  of  the  death  is  further  described  by  the  hospital  super- 
intendent as  "  infectious  febrile  disease  due  to  inoculation  with  bacillus  an- 
thracis."  The  patient  was  a  candy  packer.  On  November  14  she  was  taken 
ill.  A  physician  was  called,  and  found  a  small  gray  spot  on  her  chest,  which, 
according  to  the  patient,  had  appeared  five  days  previously.  Within  the  next 
three  days  the  spot  became  red  and  inflamed  and  her  condition  grew  so  alarm- 
ing that  she  was  sent  to  the  hospital,  where  40  c.c.  of  serum  were  injected. 
The  patient  died  12  hours  later.  The  presence  of  anthrax  bacilli  was  proved. 
Some  physicians  believed  that  the  patient  became  infected  from  a  neck  piece 
made  of  cat's  fur.  As  a  result  official  medical  inspectors  examined  a  large  num- 
ber of  fur-making  shops,  mostly  on  the  lower  East  Side,  where  the  victim 
bought  her  fur.  The  theory  was  opposed,  however,  by  another  group  of  official 
medical  men,  who  maintained  that  infection  from  cat's  fur  is  exceptionally  rare. 

No.  122,  of  Philadelphia,  Pa.,  died  at  the  age  of  69,  on  November  20,  1915,  of 
"  septicemia  due  to  malignant  pustule  on  hip ;  cirrhosis  of  liver."  The  dura- 
tion of  the  anthrax  attack  is  given  as  1  month  and  10  days,  and  the  man's 
occupation  is  given  on  the  death  certificate  as  "  cake  baker." 

No.  123,  of  Johnson  City,  N.  ¥.,  died  at  the  age  of  49  on  November  20,  1915, 
of  "  anthrax."  He  was  a  laborer  in  a  large  tannery.  His  widow  made  a  claim 
for  indemnity  under  the  New  York  workmen's  compensation  law,  and  from 
the  decision  of  the  State  industrial  commission  it  appears  that  "  while  being 
shaved  on  November  16  his  neck  was  slightly  cut  with  a  razor.  Shortly  after 
commencing  work  the  following  morning  his  neck  began  to  swell,  anthrax  germs 
having  presumably  entered  the  cut."  On  that  morning,  the  widow  states, 
"  there  was  a  little  white  spot  in  the  middle  of  the  pimple  which  appeared  to 
be  festered  and  appeared  as  though  there  was  pus  in  it.  I  took  a  needle  and 
pricked  it  and  lifted  up  the  edge  of  the  white  part,  but  no  pus  was  discharged 
but  it  bled  a  little."  Next  day  the  patient  was  removed  to  a  hospital  where 
he  died  two  days  later.  Smears  from  the  anthrax  bacilli  were  found.  The 
industrial  commission  agreed  that  the  cause  of  death  was  anthrax  and  that  it 
was  contracted  from  the  hides  among  which  the  deceased  was  working. 
Indemnity  was,  however,  denied  on  the  ground  that  the  cut  on  the  neck 
through  which  infection  took  place  was  not  received  in  the  course  of  employ- 
ment. 

No.  124,  of  Lewistown,  Mont.,  died  at  the  age  of  16,  on  November  21,  1915, 
of  "  anthrax  infection ;  septicemia."     He  was  a  farm  hand. 

No.  125,  of  Kings  County,  Cal.,  died  at  the  age  of  56,  on  November  26,  1915, 
from  "  anthrax  on  back  of  neck ;  exhaustion."  He  was  first  reported  as  a 
painter  but  later  as  a  laborer,  not  having  any  particular  kind  of  work.  His 
illness  was  stated  by  the  hospital  physician  to  be  "  due  to  infection  of  bacillus 
anthracis  producing  carbuncle  and  general  infection."  Stimulants  were  given 
but  serum  was  not  available.  He  was  ill  two  days,  and  died  an  hour  after 
arrival  at  the  hospital. 

No.  126,  of  New  Brunswick,  N.  J.,  died  at  the  age  of  25,  on  November  26, 
1915,  of  "  cellulitis  of  neck ;  sepsis ;  anthrax ;  valvular  heart  disease."  De- 
ceased was  a  laborer  and  worked  in  a  clay  pit.  The  malady  took  the  form 
of  a  large  pustule  on  the  neck,  which  the  physician  reported  was  "  genuine 
anthrax."  Anthrax  bacilli  were  found.  Serum  was  not  available;  the  illness 
lasted  three  days. 


78  BULLETIN    OF    THE   BUREAU    OF   LABOR  STATISTICS. 

No.  127,  of  Chelsea,  Mass.,  died  at  the  age  of  40,  on  November  27,  1915, 
of  "  anthrax ;  malignant  pustule."  He  was  a  freight  handler  at  the  wharves. 
"  Autopsy  showed  that  he  died  from  anthrax  septicemia,  the  principal  ana- 
tomical lesions  being  pustule  of  the  cheek,  focal  necrosis  with  hemorrhage  of 
the  stomach,  jejunum,  and  ileum;  hemorrhage  of  the  cervical  and  mesenteric 
lymph  nodes." 

No.  128,  of  Winchester,  Mass.,  died  at  the  age  of  31,  on  November  27,  1915, 
of  "  anthrax."  He  was  employed  in  a  tannery.  According  to  the  physician 
at  the  Boston  hospital  where  the  man  died,  it  was  a  fairly  typical  lesion.  A 
crucial  incision  was  made  on  the  day  of  admission.  "  Autopsy  showed  that  he 
died  from  anthrax  septicemia,  the  principal  anatomical  lesions  being  pustule 
of  the  upper  arm  (incised)  ;  enlargement  with  hemorrhage  of  the  axillary, 
mesenteric,  and  aortic  lymph  nodes ;  enlargement  and  softening  of  the  spleen ; 
focal  necrosis  and  hemorrhage  of  the  gastrointestinal  tract." 

No.  129,  of  New  York  City,  died  at  the  age  of  25,  on  November  28,  1915,  of 
"  malignant  anthrax ;  edema."    He  was  a  medical  student. 

No.  130,  of  Willington,  Conn.,  died  at  the  age  of  9,  on  December  5,  1915,  of 
"  malignant  pustule ;  general  septicemia."  No  bacteriological  culture  was 
taken,  but  according  to  the  physician  the  case  presented  a  "  perfect  clinical 
picture  of  true  anthrax."    The  girl's  occupation  is  given  as  "  at  school." 

No.  131,  of  Brooklyn,  N.  Y.,  died  at  the  age  of  45,  on  December  18,  1915, 
of  "  anthrax ;  edema  of  glottis ;  acute  cardiac  dilatation."  He  was  a  laborer 
and  handled  hides  at  the  docks.  On  admission  to  the  hospital  "  he  showed  two 
typical  punched-out  ulcers  with  escharotic  bases,  small  vesicles  surrounding 
each  lesion  with  marked  inflammatory  areolae.  There  was  intense  swelling 
and  edema  of  the  whole  right  side  of  neck  extending  down  to  chest.  Anxious 
face,  sweating  of  head,  pulse  barely  perceptible,  marked  difficulty  in  respira- 
tion and  dilated  heart.  *  *  *  Patient  complained  of  intense  general  ab- 
dominal pain  (for  which  no  reason  could  be  discovered  on  ante  mortem  ex- 
amination)." "Smears  from  lesions  of  neck  showed  anthrax  bacilli."  Serum 
"  could  not  be  obtained  in  time."  He  died  in  15£  hours  after  admission  to  the 
hospital,  the  illness  lasting  altogether  three  days. 

No.  132,  of  St.  Paul,  Minn.,  died  at  the  age  of  60,  on  December  27,  1915, 
of  "malignant  anthrax  (carbuncle)  on  back  of  neck."  He  was  a  farmer, 
and  also  occasionally  did  carpentering.  When  the  physician  was  called  he 
found  a  "  carbuncle  on  the  posterior  region  of  neck."  The  neck  was  badly 
swollen ;  an  "  incision  was  made."  The  wound  was  dressed  every  day.  Food 
and  remedies  to  sustain  strength  were  given  and  the  patient  was  kept  in 
bed.    He  was  under  the  doctor's  care  only  three  days. 

PROBABLE   RATIO  OF  DEATHS   TO  TOTAL  NUMBER   OF  CASES. 

Because  of  the  variety  and  the  incomplete  nature  of  the  material, 
any  attempt  to  estimate  the  probable  ratio  of  fatal  to  total  cases 
of  anthrax  is  surrounded  with  difficulty.  In  the  course  of  this  study, 
data  giving  figures  for  both  fatal  and  nonfatal  cases  were  secured 
from  a  number  of  different  sources,  including  a  company  physician, 
the  infectious-disease  reports  of  four  States,  occupational-disease 
reports  in  two  States,  four  hospitals,  and  a  State  workmen's  com- 
pensation commission.  The  proportion  of  fatal  to  total  cases  varied 
widely,  from  3  out  of  48,  or  6  per  cent,  in  the  experience  of  the 


ANTHEAX   AS  AN    OCCUPATIONAL   DISEASE.  79 

company  doctor,  to  15  out  of  18,  or  83  per  cent,  in  the  figures  reported 
for  two  years  to  the  New  York  State  Board  of  Health. 

Upon  closer  examination,  however,  the  discrepant  figures  seem  to 
be  susceptible  of  considerable  adjustment.  The  ratio  of  fatalities 
experienced  by  the  physician  in  question  was  probably  extraordi- 
narily low,  due  in  part  to  his  being  employed  directly  by  the  tannery 
companies,  so  that  he  received  the  cases  in  the  early  stages,  and  in 
part  to  his  considerable  experience  with  the  disease  and  the  conse- 
quent development  of  a  more  successful  treatment.  The  reports  from 
the  four  State  boards  of  health  all  covered  periods  of  two  years  or 
less,  and  showed,  respectively,  a  fatality  rate  of  2  cases  out  of  IT,  or  12 
per  cent  (Massachusetts),  4  cases  out  of  17,  or  24  per  cent  (Texas),  3 
cases  out  of  5,  or  60  per  cent  (California),  or  15  cases  out  of  18,  or 
83  per  cent  (New  York).  The  wide  range  displayed  by  these  fig- 
ures from  similar  sources  is  remarkable.  Perhaps  the  largest  single 
factor  of  error  they  contain  is  that  deaths  from  anthrax  are  likely 
to  be  reported  as  a  matter  of  routine  with  all  other  deaths,  but 
that  reports  of  nonfatal  cases  are  more  likely  to  be  neglected. 
This  would  tend  toward  a  preponderance  of  fatalities  among  the 
cases  reported,  a  tendency  the  effect  of  which  is  evidenced  by  the 
fact  that  three  of  the  ratios  in  this  group  are  higher  than  the  median 
ratio  secured,  and  that  two  of  them  are  the  highest  obtained  from 
any  source.  Moreover,  the  low  ratio  in  this  group,  that  from  Massa- 
chusetts, covers  a  period  of  only  two  months  and  four  days,  while 
there  was  an  epidemic  of  the  disease  in  that  State,  so  that  the  figures 
are  likely  to  be  unusual. 

Another  group  of  figures,  those  secured  through  the  occupational- 
disease  reports  of  two  States,  shows  a  similar  diversity,  the  New 
Jersey  ratio  for  nearly  four  years  being  1  fatal  case  out  of  13, 
or  8  per  Cent,  while  the  New  York  ratio  for  a  slightly  longer  period 
was  13  fatal  cases  out  of  23,  or  57  per  cent.  Occupational-disease 
reports,  however,  are  likely  to  suffer  from  the  defects  already  men- 
tioned as  affecting  infectious-disease  reports,  and  from  the  further 
circumstance  that  the  occupational  disease  reporting  laws  are  com- 
paratively new,  are  not  even  yet  known  to  all  physicians  to  whom 
they  apply,  and  for  business  reasons  are  not  so  likely  to  be  lived 
up  to  or  enforced.  The  figures  from  the  Massachusetts  Workmen's 
Compensation  Commission  showed  3  fatal  cases  out  of  30  in  which 
claims  for  compensation  were  made  in  three  years,  or  10  per  cent. 
Data  secured  from  such  a  source  should  be  fairly  complete ;  but,  since 
the  ratio  is  the  third  lowest  in  the  series,  it  is  probably  best  not  to 
attach  too  much  importance  to  it. 

The  figures  which  from  the  standpoint  of  accuracy  of  diagnosis 
and  completeness  of  recording  are  probably  most  valuable  for  the 
42806°— Bull.  205—17 6 


80  BULLETIN"   OF    THE   BUREAU   OP   LABOR  STATISTICS. 

purpose  in  hand  are  those  from  hospitals.  Returns  from  four  of 
these  institutions  for  widely  varying  periods  were  secured,  and  it  is 
interesting  to  note  that  the  ratios  they  present  group  closely  together 
near  the  middle  of  the  range  of  ratios  studied.  Thus  two  Massa- 
chusetts hospitals  had,  respectively,  fatality  rates  of  6  out  of  35, 
or  17  per  cent,  and  2  out  of  4,  or  50  per  cent.  A  Philadelphia 
hospital  had  6  fatal  cases  out  of  32,  or  19  per  cent,  while  a  New 
Orleans  institution  had  1  out  of  5,  or  20  per  cent.  The  first, 
third,  and  fourth  of  these  ratios  are  in  substantial  agreement;  the 
variation  shown  by  the  second  set  of  figures  is  possibly  due  to  their 
coming  from  a  small  hospital  in  the  same  city  as  the  much  larger 
institution  from  which  the  larger  number  of  cases  was  reported. 
If  the  three  sets  of  hospital  figures  which  are  in  closest  agreement, 
and  which  incidentally  include  the  largest  numbers  of  hospital  cases 
reported,  are  taken  as  a  reasonable  gauge,  the  probable  proportion 
of  fatal  to  total  cases  would  seem  to  be  about  1  out  of  5,  or  20  per 
cent.1 

LEGISLATION. 

American  legislation  regarding  anthrax  deals  (1)  with  the  re- 
porting of  cases,  (2)  with  measures  for  prevention,  and  (3)  with 
compensation  or  insurance  for  those  who  contract  the  malady  in  the 
course  of  employment.  In  none  of  these  fields  is  the  legislation  as 
thoroughgoing,  as  widespread,  or  as  vigorously  enforced  as  the  sit- 
uation demands,  but  the  beginnings  have  been  made  and  further 
study  of  the  subject  should  result  in  its  extension  and  substantial 
improvement. 

REPORTING. 

In  the  United  States,  as  in  most  civilized  countries,  the  value  of 
reporting  or  notifying  infectious  diseases  is  generally  recognized. 
Mortality  statistics  compiled  from  the  official  certificates  of  death 
indicate  roughly  the  geographical  distribution  of  a  disease  and  its 
trend  toward  higher  or  lower  frequency.  As  has  been  seen,  however, 
the  mortality  statistics  of  anthrax  cover  but  about  one-fifth  of  the 
total  number  of  cases,  and  therefore  fail  to  give  any  adequate  infor- 
mation on  its  actual  extent,  occupational  causation,  and  numerous 
other  features  of  social  interest.  Still  more  important,  only  by  re- 
porting infectious  diseases  as  soon  as  diagnosed  can  epidemics 
be  recognized,  checked,  or  prevented. 

Reporting  of  human  anthrax  is,  nevertheless,  a  comparatively  re- 
cent advance  in  this  country,  being  required,  even  as  late  as  July, 

1  This  figure  is  in  substantial  accord  with  that  of  the  British  authorities,  Bell  and 
Legge,  who  state  that  "  In  Europe  about  25  per  cent  of  all  cases  prove  fatal."  (Allbutt 
and  Rolleston :  System  of  Medicine,  1906,  p.  252.) 


ANTHRAX   AS  AN    OCCUPATIONAL   DISEASE.  81 

1911,  in  only  seven  States.  But  because  of  the  growing  frequency 
of  anthrax,  together  with  more  lively  interest  in  occupational  as 
well  as  infectious  diseases,  reporting  laws  spread  rapidly,  and  by 
January,  1916,  anthrax  had  been  made  notifiable  in  the  following 
24  States  and  in  Porto  Rico : 

Alabama,  California,  Connecticut,  Delaware,  Florida,  Illinois, 
Kansas,  Louisiana,  Maine,  Maryland,  Massachusetts,  Michigan,  Min- 
nesota, New  Hampshire,  New  Jersey,  New  York,  Ohio,  Pennsylvania, 
Rhode  Island,  South  Carolina,  South  Dakota,  Texas,  Vermont, 
and  Washington. 

In  most  of  these  anthrax  is  on  the  list  of  notifiable  infectious 
diseases,  and  reports  must  be  sent  to  the  local  board  of  health 
or  health  officer,  by  whom  they  are  transmitted  to  the  State  board 
of  health.  The  obligation  to  report  usually  rests  upon  the  phy- 
sician, and  in  some  States,  if  there  is  no  physician  in  attendance, 
any  other  person  knowing  of  the  case  is  required  to  report  it.  Some 
States  provide  for  the  payment  of  a  small  fee  to  the  physician  or 
other  person  making  the  report.  In  New  York,  for  instance,  the 
fee  is  25  cents  in  cities  and  20  cents  in  villages  and  towns.  In  Mich- 
igan and  New  Jersey,  10  cents  is  paid,  whereas  in  some  States,  such 
as  Connecticut  and  California,  the  person  reporting  is  entitled  to 
50  cents.  Failure  to  report  is  usually  punished  by  a  fine,  varying 
from  $5  in  Maryland  to  $50  in  New  Jersey.  In  some  States  the 
provisions  for  enforcement  are  more  stringent.  Thus  in  Washington 
the  State  board  of  health  may  remove  from  office  any  health  officer 
who  refuses  or  neglects  to  make  prompt  and  accurate  reports.1 

In  addition  to  requirements  for  notification  of  infectious  diseases, 
12  of  these  States2  have  adopted  statutes  or  administrative  orders 
requiring  physicians  to  report,  as  an  occupational  disease,  every  case 
of  anthrax  "  contracted  as  the  result  of  the  nature  of  the  patient's 
employment."  The  standard  certificates  used  under  these  statutes 
are  usually  made  returnable  to  the  State  board  of  health,  which 
often  must  transmit  them  to  the  State  department  of  labor;  some- 
times, however,  the  reports  go  directly  to  the  labor  department.  The 
blanks  are  more  detailed  than  the  ordinary  infectious-disease  blank, 
asking,  in  addition  to  the  name  and  address  and  nature  of  the  illness 
of  the  employee,  his  occupation,  length  of  time  therein,  and  the 

1  According  to  the  weekly  United  States  Public  Health  Reports  there  were  reported 
between  the  first  of  the  year  and  Nov.  1,  1916,  under  the  infectious  disease  reporting 
laws,  48  cases  of  anthrax,  distributed  as  follows  :  California  7,  Louisiana  6,  Massachu- 
setts 25,  Michigan  1,  New  Jersey  3,  New  York  5,  Ohio  1.  For  special  discussion  of 
anthrax  reports  received  Under  the  infectious  disease  reporting  laws  of  Pennsylvania 
and  Massachusetts,  see  pp.  31,  38,  and  70. 

a  California,  Connecticut,  Maine,  Maryland,  Massachusetts,  Michigan,  Minnesota,  New 
Hampshire,  New  Jersey,  New  York,  Ohio,  and  Rhode  Island. 


82  BULLETIN    OF    THE   BUEEAU    OF    LABOK   STATISTICS. 

employer's  name,  address,  and  business.  A  careful  study  of  occupa- 
tional hazards  is  thus  facilitated.  Two  of  these  12  States  (Cali- 
fornia and  Connecticut)  offer  a  50-cent  fee  as  an  inducement  toward 
more  thorough  reporting ;  penalties  for  failure  to  report  range  from 
$5  to  $50,  while  Minnesota  provides  as  alternative  to  a  $10  fine, 
imprisonment  for  not  more  than  10  days.1 

PREVENTION. 

The  story  told  by  such  statistics  of  anthrax  as  the  present  mor- 
tality registration  and  disease-reporting  laws  have  made  available 
is  one  of  steadily  and,  of  late,  even  sharply  increasing  prevalence. 
The  cause  of  this  condition  must  be  sought  in  the  incomplete  and  lax 
character  of  existing  efforts  at  prevention,  both  in  agriculture  and 
in  trade  and  manufacture,  especially  in  the  latter. 

Agriculture. 

Since  anthrax  in  man  is  practically  always  the  result  of  contagion 
in  some  manner  from  animals,  one  essential  in  eradicating  the  dis- 
ease is  to  prevent  it  among  animals.  Laws  and  regulations  for  the 
suppression  of  animal  anthrax  have  been  enacted  in  all  civilized 
countries  and  in  all  the  large  stock-raising  sections  of  the  United 
States. 

Congressional  action  covering  this  matter  dates  from  1865,  when 
an  act  was  passed  prohibiting  the  importation  of  cattle  from  any 
foreign  country  into  the  United  States.2  The  Secretary  of  the  Treas- 
ury was,  however,  given  power  to  suspend  the  prohibition  whenever 
he  determined  that  such  importation  would  "not  tend  to  the  intro- 
duction or  spread  of  contagious  or  infectious  diseases  among  the 
cattle  of  the  United  States."  Except  for  an  extension  to  be  men- 
tioned later,  this  provision  has  been  embodied  practically  unchanged 
in  successive  tariff  laws,  and  to-day  forms  subsection  1  of  Section 
IV-H  of  the  tariff  act  of  October  3,  1913.  Under  its  terms  importa- 
tions of  neat  cattle  were  permitted  in  the  summer  of  1916  only  from 
Great  Britain,  Ireland,  the  Channel  Islands.  New  Zealand,  and 
North  America.  In  1884.  with  the  organization  of  the  Bureau  of 
Animal  Industry  in  the  Department  of  Agriculture,  the  formulation 
of  rules  governing  importations  of  live  stock  was  taken  over  by  that 
department. 

1  For  summaries  of  cases  reported  under  the  New  York  and  the  New  Jersey  occupa- 
tional disease  reporting  statutes,  see  pp.  35  and  37.  In  New  Hampshire  2  cases  were 
reported  under  this  law  in  1815.  Both  patients  were  laborers  in  a  tannery,  and  both 
recovered.  In  Maryland  the  remarkable  case  was  reported  in  1914  of  a  15-year-old  boy 
who  contracted  the  disease  while  working  as  a  doffer  in  a  woolen  mill. 

2  United  States,  Statutes  at  Large,  Vol.  XIV,  p.  1. 


ANTHEAX   AS   AN"    OCCUPATIONAL  DISEASE.  83 

In  most  States,  also,  the  regulations  do  not  refer  specially  to 
anthrax,  but  appty  to  infectious  cattle  diseases  in  general.  Almost 
all  of  these  States  forbid  the  importation  of  animals  affected  with 
contagious  or  infectious  diseases.  Cases  of  such  diseases  must  be  re- 
ported, and  an  official  of  the  veterinary  department  is  required  to  in- 
vestigate, to  examine  the  stock,  and  to  prescribe  necessary  measures 
for  the  protection  of  healthy  stock.  Diseased  animals  or  those  which 
have  been  exposed  to  the  disease  must  be  quarantined.  To  prevent 
further  spread  of  the  disease  many  States  prescribe  the  killing  of 
affected  or  exposed  animals;  frequently  in  such  cases  an  official  or  a 
committee  appraises  the  animals  and  the  owner  is  compensated  for 
the  loss.  Complete  and  careful  destruction  of  carcasses  of  animals 
dying  of  the  disease  and  disinfection  of  their  stalls  are  also  required. 
Failure  to  comply  with  the  regulations  is  punishable  by  a  fine 
ranging,  for  ordinary  offenses,  from  $5  to  $500.  Penalties  as  high 
as  $5,000  may  be  levied  in  Tennessee  for  importing  diseased  stock, 
and  in  Virginia  for  failure  to  disinfect  freight  cars. 

Several  States,  however,  chiefly  in  the  West  and  South,  where 
stock  raising  is  an  important  industry  and  where  anthrax  is  prev- 
alent, have  prescribed  measures  specifically  for  the  prevention  and 
eradication  of  this  scourge.  These  measures  are  on  the  whole  similar 
to  the  general  regulations  just  described.  Periodic  vaccination  of 
herds,  which  is  compulsory  in  a  number  of  countries  abroad  and 
which  has  proved  its  effectiveness  as  a  preventive  measure,  is  strongly 
advocated  by  agricultural  stations  in  this  country  but  is  required  in 
only  a  few  States.  In  Kentucky,  vaccination  is  prescribed  for  all 
animals  which  have  been  exposed  to  the  disease.  The  vaccine  must 
be  approved  by  the  United  States  Bureau  of  Animal  Industry,  by 
the  Kentucky  Agricultural  Experiment  Station,  or  by  the  State  live 
stock  sanitary  board.  In  Pennsylvania  the  State  live  stock  sanitary 
board,  according  to  one  of  its  officials,  prepares  and  distributes  to 
qualified  veterinarians,  free  of  cost,  anthrax  vaccine  for  use  on  ex- 
posed animals.  Early  each  spring,  for  years,  it  is  reported,  the 
board  has  vaccinated  the  stock  on  all  premises  where  anthrax  is 
known  recently  to  have  existed.  Formerly  the  vaccine  was  furnished 
free  of  cost  and  the  work  carried  on  at  the  expense  of  the  State. 
Since  1916,  however,  the  State  merely  supplies  the  vaccine  and  does 
not  pay  for  its  administration.  Similar  precautions  are  being  taken 
in  other  States.1 

1  During  June  and  July  of  1916  serious  anthrax  outbreaks  occurred  among  cattle  in 
the  neighborhood  of  Buffalo,  N.  T.,  in  Arkansas  and  Texas  and  in  the  Mississippi  Delta 
region  of  Louisiana.  Prompt  work  by  State  veterinary  officers  in  killing  infected  cattle, 
securing  their  burning  or  deep  burial  in  quicklime,  vaccinating  exposed  herds,  and  estab- 
lishing quarantines,  succeeded  in  checking  the  plague.  Several  human  cases  were  re- 
ported in  this  connection,  including  the  death  of  the  State  veterinarian  of  Texas. 


84 


BULLETIN"   OF   THE  BUREAU   OF   LABOR  STATISTICS. 


Trade  and  Manufacture. 

The  question  of  prevention  of  anthrax  among  industrial  workers, 
which  is  the  subject  of  extensive  legislation  in  the  leading  countries 
of  Europe,  has  so  far  received  little  attention  in  the  United  States. 
Not  a  single  special  factory  or  workshop  regulation  for  the  safe- 
guarding of  employees  against  this  disease  has  yet  been  enacted 
by  any  State.  What  governmental  precautions  do  exist  refer  only 
to  the  importation  of  dangerous  animal  materials  and  until  January 
1,  1917,  these  were  limited  in  application  to  hides  and  glue  stock 
from  "neat  cattle."  The  dangers  lurking  in  imported  hair,  wool, 
and  bristles,  in  horsehides,  and  in  goat  and  sheep  skins  were  com- 
pletely ignored.0 

Imports  for  the  six  years  ending  June  30,  1915,  of  animal  materials 
liable  to  carry  anthrax  are  shown  in  the  following  table,  in  which  the 
figures  represent  thousands  of  pounds : 

Table  7.— IMPORTS  OF  ANIMAL  PRODUCTS  LIABLE  TO  BE  INFECTED  WITH 
ANTHRAX,  1910  TO   1915. 

[Compiled  from  reports  of  United  States  Bureau  of  Foreign  and  Domestic  Commerce  on  imports  of  mer- 
chandise into  the  United  States.    Figures  represent  thousands  of  pounds.] 


Materials  and  the  country  from  which 

Year  ending  June  30- 

exported. 

1910 

1911 

1912 

1913 

1914 

1915 

HIDES  AND  SKINS,  EAW  OE  UNCURED. 

Dry: 

Total 

i  608,615 

1 152, 802 

i  89, 235 

17,490 

(2) 
(2) 
(2) 
(2) 

263,927 

37,341 

59, 921 

145 

18,759 

2,941 
130 

4,029 
1,722 

177,746 
51, 639 
45, 433 
6,593 

197,140 

27, 295 
22,345 

234,914 
76,324 
45,  515 
6,317 

302,849 

57, 656 

26,331 

22 

193,399 

30, 626 

50,679 

342 

16,176 

2,625 
343 

3,461 

1,565 

257,373 
55, 972 
72, 177 
6,432 

314,817 

52,504 

26,995 

399 

195,292 

29,188 

55,  415 

387 

16,495 

2,313 

451 

3,578 

1,483 

231,183 

54,107 

60,873 

5,676 

329,880 

71,809 

23,440 

1,209 

247,645 

47,504 

44, 343 

711 

14,245 

1,573 

200 

3,436 
1,592 

209,119 

71,085 

64,881 

13, 777 

Green  or  pickled: 

Total 

329,095 

135, 191 

18,835 

420 

WOOL,  HAIR  OF  THE  CAMEL,  GOAT,  ALPACA, 
AND    OTHEE    LIKE    ANIMALS,    MANUFAC- 
TUEED. 

Total... 

137,646 

21, 021 

38, 987 

121 

7,534 

2,426 

75 

3,553 
1,491 

308,081 

95, 734 

40,959 

25,068 

HOESE  AND   OTHEE  ANIMAL   HAIR   MANH- 
FACTUEED. 

Total 

11,689 

South  America 

1,872 

416 

BEISTLES. 

Total 

4,061 

2,482 

1  Including  dry,  green,  and  picked  hides  and  skins. 

2  Included  in  dry  hides  and  skins. 

a  Certain  regulations  did  exist  regarding  the  disinfection  of  wool,  horse,  and  other  hair 
imported  from  South  America,  but  these  had  reference  only  to  foot-and-mouth  disease. 
(Treasury  decisions  30783,  July  13,  1910,  and  32027,  Nov.  23,  1911.)  It  is  said  that  in 
one  State  the  board  of  health  requires  hair  shipped  into  the  State  to  be  submitted  to  a 
temperature  of  200°  F.,  but  this  report  could  not  be  verified. 


ANTHRAX   AS   AN"    OCCUPATIONAL   DISEASE.  85 

Precautions  for  obviating  the  danger  of  anthrax  from  imported 
animal  materials  were  first  taken  by  Congress  in  1866.  In  that  year 
the  same  Congress  which  had  limited  the  importation  of  cattle  as 
already  described  amended  the  law  to  apply  as  well  to  the  "  hides  of 
neat  cattle." x  Incorporated  in  the  original  statute  which  it  extended, 
this  amendment  also  has  come  down  to  the  present  time  as  part  of 
the  tariff  law.  While  the  Department  of  Agriculture,  as  stated,  has 
taken  over  the  regulation  of  live-stock  importations,  the  Treasury 
Department  still  has  charge  of  the  regulation  of  hide  imports,  the 
actual  administration  of  both  sets  of  rules,  however,  being  performed 
by  the  Quarantine  Division  of  the  Bureau  of  Animal  Industry. 

The  tariff  clause  under  discussion,  however,  provides  only  for  the 
unregulated  entry  or  the  absolute  exclusion  of  hides  from  suspected 
areas,  and  is  therefore  likely  in  application  to  be  either  too  lax  or 
too  strict.  More  precise  safeguards  against  anthrax  were  needed, 
and  are  now  authorized  by  section  2  of  the  act  of  February  2,  1903.2 
This  section  empowers  the  Secretary  of  Agriculture  to  take  meas- 
ures against  the  introduction  of  contagious  diseases  of  animals  from 
a  foreign  country  into  the  United  States  or  from  one  State  of  the 
United  States  into  another.  In  pursuance  of  this  act  the  Secretary 
of  Agriculture  has  at  various  times  made  recommendations  for  the 
disinfection  of  imported  hides,  with  special  care  against  anthrax, 
and  rules  embodying  these  recommendations  have  been  issued  by  the 
Division  of  Customs  of  the  Treasury  Department. 

The  rules  in  force  during  1916  were  based  on  an  order  which  went 
into  effect  June  1,  1910.3  It  required  that  untanned  hides  of  neat 
cattle  (later  interpreted  to  include  buffalo4),  hide  cuttings  or  par- 
ings, and  glue  stock,  shipped  from  districts  where  anthrax  was  known 
to  the  American  consul  to  be  prevalent,  undergo  disinfection  by  im- 
mersion for  at  least  30  minutes  in  a  1  to  1,000  solution  of  bichloride  of 
mercury.  Consuls  in  such  districts  were  instructed  to  refuse  the 
certification  of  invoices  covering  the  above  products  for  shipment  to 
this  country  unless  they  were  disinfected  hj  the  prescribed  method, 
and  admission  was  refused  to  products  requiring  disinfection  which 
lacked  the  proper  certificate.  Disinfection  of  suspected  products  on 
the  dock  upon  arrival  in  this  country  or  their  transportation  across 
American  territory  was  not  permitted,  as  it  might  tend  to  propa- 
gate the  disease  in  this  country.  Disinfection  was  also  required 
for  hides  produced  in  Xorth  America  if  landed  and  transshipped  in 
another  country  in  the  course  of  importation.     The  rules  did  not 

1  United  States.   Statutes  at  Large,  Vol.  XIV,  p.   3. 

2  United  States,  32  Stat.,  791. 

3  Treasury  decision  30583,  May  2,  1910.  Also  known  as  Treasury  Department  Circular 
No.  23    (Division  of  Customs). 

*  Treasury  decision  31981,  Nov.  2,  1911. 


86  -BULLETIN"   OP    THE   BUREAU    OF    LABOR    STATISTICS. 

apply,  however,  to  goatskins,  sheepskins,  or  articles  manufactured 
from  the  hides  of  neat  cattle. 

The  delay  and  expense  necessitated  by  even  these  mild  regulations 
caused  considerable  opposition  among  American  importers,  which 
may  have  been  increased  by  the  cutting  off,  through  the  war,  of 
hide  importations  from  Europe,  especially  from  Russia,  and  the 
consequent  augmentation  of  imports  from  more  dangerous  sources, 
such  as  China.  Moreover,  tests  seemed  to  show  that  soaking  in 
bichloride  of  mercury  solution  of  the  prescribed  strength  for  so 
brief  a  period  as  half  an  hour  was  totally  insufficient  to  exterminate 
anthrax  spores.1 

Accordingly,  late  in  1915,  the  regulations  were  modified 2  to  permit 
the  substitution  of  either  of  two  methods  of  disinfection  which  ex- 
periment had  indicated  were  more  efficacious.  One  of  these  was 
immersion  for  not  less  than  48  hours  in  a  solution  containing  10 
per  cent  of  sodium  chloride  (common  salt)  and  2  per  cent  of  hydro- 
chloric acid  in  water;  the  other  was  immersion  for  not  less  than  24 
hours  in  a  solution  containing  2,500  parts  of  a  1  per  cent  formic 
acid  solution  and  1  part  of  mercuric  chloride.3  The  Secretary  of 
Agriculture,  according  to  the  order,  stated  that  "these  methods  of 
disinfection  for  anthrax  hides  or  anthrax  suspected  hides  will  be 
acceptable  to  his  department." 

In  a  little  over  four  months,  however,  another  amendment  to  the 
regulations  was  issued  which,  as  far  as  anthrax  is  concerned,  almost 
completely  frustrated  their  purpose.  This  remarkable  amendment 4 
provided  that  "  in  future  when  a  shipment  of  hides  which  requires 
*  *  *  a  certificate  of  disinfection  arrives  without  such  certificate  " 
the  importer  might  apply  for  permission  to  perform  the  disinfection 
at  his  tannery.  If  the  importer  had  "  proper  facilities  "  the  Depart- 
ment of  Agriculture  was  to  permit  the  disinfection  under  supervision 
of  an  inspector  from  the  Bureau  of  Animal  Industry,  and  the  cus- 
toms collector,  upon  being  so  advised,  "  shall  permit  the  hides  to  go 
forward  from  the  port  of  entry  to  the  tannery  under  customs  seals," 
notification  of  his  action  being  sent  to  the  inspector  who  is  to  super- 
vise the  disinfection. 

It  has  been  seen,  however,  that  in  almost  every  group  of  cases 
studied  most  of  the  tannery  workers  contracting  anthrax  did  so  in 
the  early  processes  of  trucking  the  hides  to  the  tannery,  receiving, 
checking,  sorting,  and  storing  them.  Another  striking  revelation  is 
the  large  proportion  of  cases  among  longshoremen,  teamsters,  and 
other  baggage  handlers,  including  even  a  Government  weigher  at- 

1  See  p.  118.  3  The  same  as  bichloride  of  mercury. 

2  Treasury  decision  35761,  Oct.  11,  1915.         4  Treasury  decision  361S8.  Feb.  25,  1916. 


ANTHRAX   AS  AN    OCCUPATIONAL   DISEASE.  87 

tached  to  the  customhouse.1  In  view  of  these  facts,  it  would  seem 
that  permitting  suspected  materials  to  arrive  in  America  and  to 
spread  contagion  in  their  wake  from  dock  to  railroad,  from  railroad 
to  dray,  and  from  dray  to  warehouse  and  tannery  before  they  were 
finally  disinfected  was  a  violation  of  elemental  principles  of  caution 
and  sanitation. 

Nevertheless,  the  Agriculture  and  the  Treasury  Departments  con- 
tinued to  weaken  their  requirements.  Under  date  of  April  20,  1916, 
still  another  modification 2  was  promulgated,  setting  forth  that  there- 
after even  "  foreign  hides  which  can  not  be  certified  by  an  American 
consul  as  coming  from  a  district  in  which  *  *  *  anthrax  is  not 
prevalent"  were  to  be  allowed  the  right  of  shipment.  The  only 
restriction  was  that  the  bales  must  "  have  been  whitewashed  under 
consular  supervision,"  and  that  they  were  "  subject  to  disinfection 
after  arrival  at  destination  in  this  country."  The  provisions  for 
supervising  the  disinfection  at  destination  remained  the  same  as 
before,  but  the  process  was  made  more  thorough,  immersion  in  a 
1  to  1,000  solution  of  bichloride  of  mercury  for  at  least  48  hours 
being  now  required.  While  this  rule  extended  a  measure  of  protec- 
tion to  tannery  workers  in  the  later  processes  which  even  the  original 
requirement  of  disinfection  for  30  minutes  did  not  afford,  it  still 
left  transportation  workers  and  those  engaged  in  receiving  the 
hides  at  the  tanneries  exposed  to  the  full  hazard  of  the  disease. 
However,  even  the  prescribed  method  of  disinfection  was  not  always 
sufficient  to  destroy  the  anthrax  spore.  Moreover,  there  were  serious 
difficulties  in  the  way  of  enforcement,  since  the  consuls,  who  were  to 
require  the  whitewashing  of  hides  coming  from  anthrax-infected 
districts,  did  not  always  possess  sufficient  information  as  to  the  loca- 
tion of  the  outbreaks.  This  source  of  danger  was  pointed  out  as  early 
as  1897.  "  Some  of  these  officers  (consuls)  have  frankly  stated  that 
the  regulations  for  the  disinfection  of  hides  were  not  and  could  not 
be  enforced  by  them."3 

Under  these  circumstances  the  increasing  number  of  anthrax  cases 
continued  to  force  attention,  and  in  the  fall  of  1916  a  special  commit- 
tee of  the  National  Association  of  Tanners  cooperated  with  the 
Federal  authorities  in  the  preparation  of  more  effective  provisions 
for  the  disinfection  of  imported  hides.4  Under  the  new  regulations 
the  importation  of  hides,  wool,  glue  stock,  or  other  products  from 
animals  affected  with  anthrax  is  prohibited.  For  hides  from 
anthrax-infested  districts  the  30  minutes'  immersion  in  1  to  1,000 

1  See  fatal  case  No.  Ill,  p.  75. 

2  Treasury  decision  38332,  Apr.  20,  1016. 

3  Delaware  College  Agricultural  Experiment  Station:  Anthrax,  A  Study  of  National 
and  of  State  Legislation  on  This  Subject,  Bui.  No.  XXXVII,  1898. 

4  Now  issued  as  United  States  Treasury  Department  and  Department  of  Agriculture 
Joint  Order  No.   1,  effective  Jan.  1,   1917.      (See   Appendix   A.) 


88  BULLETIN    OF    THE   BUREAU    OF    LABOR   STATISTICS. 

bichloride  of  mercury  solution  allowed  at  the  port  of  shipment  is 
extended  to  24  hours'  immersion.  Materials  shipped  without  disin- 
fection and  without  a  consular  certificate  showing  nonprevalence  of 
anthrax  may  still  be  received  in  this  country  and  transported,  under 
customs  seals,  to  the  tannery,  where  they  are  to  be  disinfected  under 
supervision  of  an  agent  of  the  Bureau  of  Animal  Industry  at  the 
tannery's  expense.  The  previous  method  of  disinfection  at  the 
tannery,  namely,  soaking  for  not  less  than  48  hours  in  a  1  to  1,000 
bichloride  of  mercury  solution,  is  still  accepted,  but  as  a  substitute 
hides  may  be  immersed  for  not  less  than  six  days  in  a  1  to  5,000 
bichloride  of  mercury  solution,  followed  by  not  less  than  5  days  in 
lime  of  the  usual  strength  for  dehairing,  which  is  believed  by  the 
bureau  effectively  to  disinfect  hides  against  anthrax.1  The  new 
regulations  also  contain  for  the  first  time  detailed  requirements  for 
the  disinfection  of  glue  stock,  bones,  hoofs,  wool,  and  hair,  and  of 
cars,  boats,  other  vehicles,  and  certain  premises.2 

The  growing  frequency  of  anthrax  among  industrial  workers  in 
ATew  York  and  Massachusetts  during  1915  and  the  early  part  of  1916 
stimulated  interest  in  the  question  among  officials  of  these  States. 
In  Xew  York  the  industrial  commission  investigated  the  reported 
cases  which  developed  during  the  last  10  months  of  1915,  and  called 
a  conference  on  the  subject  for  March  27,  1916.  Four  State  depart- 
ments were  represented — the  conservation  commission,  the  depart- 
ment of  agriculture,  the  department  of  health,  and  the  industrial 
commission.  The  conservation  commission  reported  that  in  response 
to  a  petition  from  the  residents  of  one  county,  who  complained  of  a 
leather  factory  as  the  polluting  agent,  it  was  studying  the  relation 
of  stream  pollution  to  anthrax.  Appointment  of  a  committee  of  one 
representative  from  each  department  was  suggested  for  the  purpose 
of  studying  the  question  thoroughly.  Recommendations  later  issued 
by  the  division  of  industrial  hygiene  of  the  industrial  commission 
are  reprinted  in  Appendix  A. 

In  Massachusetts  the  occurrence,  early  in  1916,  of  25  cases,  at  least 
four  of  which  were  fatal,  and  which  centered  among  the  tannery 
workers  at  Woburn  and  Winchester,  started  an  investigation  by  the 
State  department  of  health,  with  the  cooperation  of  the  board  of 
labor  and  industries.  Investigators  were  sent  to  near-by  States  to 
trace  the  suspected  shipments  of  hides  to  their  source  and  to  learn 
whether  cases  had  been  caused  by  them  elsewhere.  It  was  found 
that  20  of  the  cases  were  infected  from  one  source,  a  cargo  of  dried 
hides  from  China.3  Eules  subsequently  suggested  by  the  State  board 
of  labor  and  industries  for  the  handling  of  hides,  skins,  and  wool 
are  reprinted  in  Appendix  A. 

1  See  p.   120. 

2  See  Appendix  A. 

3  United  States  Public  Health  Reports,  Dec.   15,   1916,  pp.  3399-3402. 


ANTHRAX   AS   AN    OCCUPATIONAL   DISEASE. 


89 


COMPENSATION. 

Also,  in  the  matter  of  workmen's  compensation  for  victims  of  oc- 
cupational anthrax  the  United  States  has  made  but  little  progress — 
much  less  than  other  leading  countries.  While  Great  Britain,  Ger- 
many, France,  Holland,  Italy,  South  Australia,  and  the  Canadian 
Province  of  Ontario  have  for  years  been  awarding  such  compensa- 
tion, in  the  United  States  only  one  State  is  as  yet  acting  consistently 
on  this  principle. 

The  Massachusetts  workmen's  compensation  law,  when  it  was 
drafted,  was  made  to  cover  "personal  injury,"  instead  of  merely 
"  personal  injury  by  accident "  as  did  most  of  the  other  State  laws. 
Occupational  diseases  were  thus  included,  and  during  the  first  three 
years  of  the  operation  of  the  act,  closing  June  30,  1915,  there  were 
filed  with  the  industrial  accident  board  30  claims  for  compensation 
on  account  of  occupational  anthrax,  in  17  of  which  awards  were 
made. 

Table  8.— CLAIMS  FOR  COMPENSATION  ON  ACCOUNT  OF  ANTHRAX  FILED  UNDER 
THE  MASSACHUSETTS  WORKMEN'S  COMPENSATION  LAW,  3  YEARS  ENDING  JUNE 
30,  1915. 


Occupation. 


Duration  of 
disability. 


Compensation. 


Indemnity  for  wage  loss. 


Medical  aid. 


HIDE  AND  SKIN  "WORKERS. 


Lumper  in  beam  house 

Beamster 

Machine  operator  in  beam  house.. . 

Lumper : 

Lumper  in  dry  loft 

Lumper  in  storehouse 

Lumper  in  beam  house 

Tanner 

Do 

do.:....:. 

Leather  finisher  doing  "seasoning". 
Foreman  in  rough  stock  department 

Laborer  in  leather  factory 

Tanner 

Lumper 

Splitter  of  skins  in  leather  factory. . . 
Lumper  in  coloring  room  of  a  calf- 
skin tannery. 
Worker  in  soaks  in  beam  house 


TRANSPORTATION  WORKERS. 


Longshoreman 

Do 

Do 

Do 

Do 

Do 

Laborer  for  private  weigher. 

Do 

Do 


"WOOL  AND  HAIR  WORKERS. 

Foreman  wool-pulling  department. 

Picker  hand  in  felt  factory 

Brush  drawer  in  brush  factory 


No  disability. 

1  week 

If  weeks 

If  weeks 

2f  weeks 

2f  weeks 

24  weeks 

3  weeks 

3f  weeks 

4  weeks 

5*  weeks 

6  weeks 

....do 

6f  weeks 

7  weeks 

7?  weeks 

Fatal 


.do. 


1  week 

34  weeks . . 
5»  weeks.. 
6  weeks . . . 
85  weeks . . 

Fatal 

7?  weeks.. 
15  weeks.. 
15?  weeks . 


2  weeks 

llf  weeks 

Over    2    years; 

exact  time  not 

reported. 


None  due 

do 

do 

do 

$2.86 

$2.57 

$5.43 

Not  reported. 

do 

do 

$14.28 

$18.00 

$16.00 

Not  reported . 
$21.43 


$23.79 

Unable  to  locate  dependents  in 

Europe. 
do 


None  due. 
$11.42 


$24.00. 
$58.04. 


$34.46.. 
$78.00.. 
$110.86. 


C1) 


None  due . 

$83.84 

$754.69.... 


Not  reported. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 
$5.00. 
Not  reported. 

Do. 

Do. 

Do. 

Do. 

Do. 

Do. 


Do. 
Do. 

$16.00. 

Not  reported. 
Do. 
(l) 
Not  reported. 
$56.00. 
$1.00. 


$9.50. 

Not  reported. 

$18. 29. 


Compensation  refused. 


90  BULLETIN    OF    THE   BITKEAU    OF    LABOR   STATISTICS. 

Hide  and  skin  workers  made  up  over  one-half  of  the  claimants, 
or  18  out  of  the  30.  Of  these,  seven  were  "  lumpers  "  in  leather  fac- 
tories, six  of  whom  were  employed  in  one  establishment  in  Salem. 
One  was  a  foreman  in  the  "  rough  stock  "  department  in  a  goat  and 
sheepskin  tannery ;  one  was  splitting  skins  in  a  leather  factory ;  one 
was  a  leather  finisher  engaged  in  "  seasoning  " — he  applied  finish  to 
skins  with  a  sponge,  and  an  "  eruption  on  both  his  hands  and  fore- 
arms "  is  reported.  One  tannery  employee  worked  in  "  soaks  in  beam 
house " ;  there  were  also  a  "  machine  operator  in  beam  house,"  a 
"  beamster,"  and  a  laborer,  all  employed  in  leather  factories.  In  four 
cases  it  was  merely  stated  the  "  men  worked  in  tanneries." 

Transportation  workers  were  represented  by  nine  claimants.  Six 
of  these  were  longshoremen,  of  whom  five  were  employed  by  one 
concern  in  Boston.  One  was,  by  his  own  testimony,  on  or  about  July 
24,  "  discharging  buffalo  hides  from  a  steamship.  I  had  been  on  this 
job  four  days  when  I  got  a  scratch  on  my  arm.  The  following  day 
I  noticed  something  like  a  wart  which  was  itchy.  I  finished  the  job 
and  there  was  no  work  until  August  5.  I  started  to  go  to  work  on 
this  day,  but  my  arm  was  itchy  and  sore,  and  I  went  to  the  hospital 
instead,  where  they  said  I  had  anthrax,  and  was  operated  on  right 
away."  Another  of  the  longshoremen  "had  been  pushing  behind 
truck  unloading  hides  for  three  days,  and  he  stopped  work  at  the  end 
of  the  third  day,  as  his  hands  began  to  swell  " ;  two  were  "  handling 
salt  hides,"  and  one  "  green  "  hides,  at  the  time  they  contracted  an- 
thrax ;  the  sixth  was  unloading  wool  and  hides,  in  addition  to  other 
cargo.  The  remaining  three  transportation  workers  were  reported  as 
"  laborers,"  all  employed  by  a  firm  of  weighers  in  Boston. 

Two  cases  occurred  among  woolworkers;  one  was  a  foreman  in  the 
wool-pulling  department  of  an  establishment  where  wool  was  pulled 
and  scoured;  the  other  was  a  "  picker  hand  "  in  a  felt  factory.  The 
report  reacls :  "  Sliver  ran  into  his  leg.  It  was  removed  and  leg  was 
poisoned  from  wool.  Anthrax  and  complications  on  left  lower  ex- 
tremity." 

One  applicant  for  compensation  was  a  brush  drawer.  She  scratched 
her  face  over  the  left  eye,  and  as  a  result  anthrax  developed. 

The  periods  of  disability  ranged  from  one  week  to  over  two  years. 
In  one  case  no  disability  resulted  and  the  employee  remained  at 
work;  five  workers  were  disabled  from  one  to  two  weeks.  In  none 
of  these  six  cases  was  compensation  awarded,  as  the  law  requires  a 
waiting  period  of  two  weeks.  Medical  aid  is  allowed  by  the  Massa- 
chusetts law  from  the  day  of  disability,  but  in  only  one  of  these  six 
cases  was  it  stated  that  such  aid  was  given.  In  the  remaining  cases 
disability  lasted  beyond  two  weeks,  and  17  awards  for  compensation, 
beginning  with  the  third  week  and  equal  to  two-thirds  of  average 
weekly  wages,  were  made.     The  amounts  ranged  from  $2.57  for  a 


ANTHRAX    AS    AN    OCCUPATIONAL   DISEASE.  91 

disability  of  two  and  two-sevenths  weeks  to  $754.69  for  a  disability 
of  over  two  years.  This  case  was  finally  disposed  of  by  a  lump-sum 
payment  toward  the  close  of  the  second  year  of  weekly  payments. 
In  addition  to  the  weekly  indemnity  for  loss  of  wages,  medical 
attendance  costing  from  $1  to  $56  was  paid  for  in  at  least  six  cases. 

Three  of  the  claims  were  filed  in  behalf  of  workers  whose  anthrax 
attacks  ended  fatally,  the  course  of  the  disease  being  extremely  rapid 
in  all  three  instances.  Two  of  the  victims  were  taken  to  a  hospital 
two  days  after  they  began  to  feel  ill ;  one  died  in  five  hours  and  the 
other  in  17  hours  after  admission.  In  neither  of  these  cases  was 
compensation  paid,  as  it  was  impossible  to  locate  the  dependents  in 
Europe.  In  the  third  fatal  case,  in  which  death  occurred  three  days 
after  admission  to  the  hospital,  the  claim  for  compensation  filed  by 
the  victim's  mother  was  disallowed  by  the  arbitration  committee  to 
which  it  was  referred.  While  there  was  no  question  as  to  the  cause 
of  death,  the  insurer  contended  that  the  disease  was  not  contracted 
while  the  deceased  was  in  the  employ  of  their  policyholder,  but  while 
working  for  another  company,  which  was  not  insured  under  the  act. 

One-third  (10)  of  the  cases  considered  in  this  section  occurred  in 
Boston.  Six  were  from  Salem;  Haverhill,  Peabody,  and  Lynn  fur- 
nished each  two  cases ;  Worcester,  Davenport,  Millbury,  and  Woburn, 
one  case  each;  in  the  remaining  four  cases  the  place  of  employment 
could  not  be  ascertained.  Only  one  of  those  injured  was  a  woman. 
The  youngest  was  17  years  old;  one-half,  or  15,  were  between  the 
ages  of  20  and  29,  eight  were  between  30  and  39,  five  between  40  and 
49,  and  one  was  60  years  of  age. 

Most  frequently,  or  in  nine  cases,  the  lesions  were  on  the  face.  In 
seven  they  were  on  the  hand  or  arm ;  five  workers,  of  whom  one  died, 
had  the  pustule  on  the  neck ;  one,  who  died,  had  it  on  the  chest,  and 
one  On  the  leg.  In  the  seven  other  cases  the  location  of  the  lesion  was 
not  stated ;  one  of  these,  however,  ended  fatally  and,  judging  by  the 
symptoms,  it  was  probably  a  case  of  internal  anthrax.  The  cause  of 
death  was  given  as  "  lobar  pneumonia,"  and  for  this  reason  the  case 
was  not  listed  among  those  reported  in  the  United  States  registration 
area.  Nevertheless,  a  blood  smear  sent  to  Harvard  Medical  School 
showed  the  presence  of  anthrax  bacilli. 

Another  State  which  has  taken  the  same  enlightened  position  as 
Massachusetts  is  California.  The  compensation  statute  of  this 
western  Commonwealth  applied,  as  enacted,  only  to  "  personal  in- 
jury sustained  ...  by  accident."  By  amendment  in  1915  the  words 
"  by  accident "  were  stricken  out,  so  that  the  law  is  now  as  broad 
in  scope  as  that  of  Massachusetts.  Up  to  May  1,  1916,  however, 
no  claim  for  anthrax  had  been  presented  to  the  industrial  accident 
commission,  so  that  the  first  California  award  for  this  trade  illness 
had  still  to  be  made.     In  1915,  also,  Pennsylvania   amended   its 


9*2  BULLETIN"   OF    THE   BUREAU   OF   LABOR  STATISTICS. 

constitution  to  allow  the  passage  of  a  law  establishing  compensa- 
tion for  occupational  diseases,  and  the  legislature  of  1917  will  have 
an  opportunity  to  enact  the  necessary  legislation. 

The  compensation  laws  of  the  remaining  States  do  not  cover  dis- 
eases of  occupation.  Nevertheless  in  a  certain  number  of  cases 
indemnity  for  anthrax  has  been  allowed  when  infection  developed 
as  a  result  of  an  accidental  injury  sustained  by  the  worker  in  the 
course  of  employment. 

In  New  York,  for  instance,  five  such  claims  were  filed  during  the 
first  22  months  of  the  operation  of  the  act  (July  1,  1914,  to  May  1, 
1916).  In  three  cases  agreements  were  arrived  at  between  the  in- 
jured workmen  and  the  insurance  carriers,  and  compensation  for 
periods  ranging  from  two  to  six  and  two-sixths  weeks  had  already 
been  paid  at  the  time  of  this  writing.  In  another  case,  in  which 
death  occurred,  it  was  recommended  that  the  claim  be  disallowed  as 
the  scratch  through  which  infection  occurred  was  received  while  the 
man  was  being  shaved,  and  was  not  due  to  an  accident  in  the  course 
of  employment.1  On  the  remaining  claim,  which  was  the  first  to  be 
presented  in  New  York,  the  commission  awarded  seven  and  five- 
sixths  weeks'  compensation.  The  insurance  company  took  an  appeal, 
but  later  withdrew  it  and  paid  the  claim.  The  workman  concerned, 
an  employee  in  a  plant  where  raw  skins  are  handled,  was  trimming 
sheepskins  on  the  day  of  the  accident.  He  hit  his  jaw  against  the 
beam  on  which  he  was  placing  skins  for  the  purpose  of  cutting  off 
the  head,  tail,  and  legs.  The  accident  occurred  in  the  forenoon  and 
caused  an  abrasion  of  the  skin,  with  pain  and  smarting,  so  that 
during  the  afternoon  the  claimant  frequently  rubbed  the  sore  place 
with  his  hand.  On  the  next  day  a  doctor  was  called  in,  found  a 
pustule  at  the  seat  of  the  injury,  and  diagnosed  the  case  as  anthrax. 
The  commission  decided  that  the  injury  "  was  an  accidental  injury, 
and  arose  out  of  and  in  the  course  of  his  employment."  The  in- 
surance carrier  appealed  on  the  ground  that  anthrax  is  an  occupa- 
tional disease  in  tanning,  and  that  therefore  the  compensation  act 
does  not  require  damages,  but  the  court  sustained  the  commission, 
thus  establishing  a  favorable  precedent  for  New  York  State.2 

The  situation  in  New  Jersey  is  the  same  as  that  in  New  York. 
Records  of  the  employers'  liability  commission  in  that  State  for  the 
year  1915  reveal  four  cases  in  which  "  there  was  previously  a  specific 
accident  which  later  became  infected  (anthrax)."  In  three  cases 
the  employees  were  working  on  hides  and  skins;  the  occupation  of 
the  fourth  worker  is  not  given ;  it  is  merely  stated  that  he  was  in- 
jured on  a  shearing  machine.     One  was  a  fatal  case;  the  other  em- 

1  For  authentic  cases  of  infection  through  shaving  brushes,   see  p.  23. 
-  The  appeal  was  argued  in  the  Appellate  Division  of  the  Supreme  Court,  at  Albany, 
during  the  May,   1916,   term. 


ANTHRAX   AS  AN   OCCUPATIONAL  DISEASE.  93 

ployees  were  out  for  three,  five  and  two-sixths,  and  eight  weeks,  re- 
spectively. The  amounts  awarded  in  the  fatal  case,  where  there 
were  no  dependents,  were  $100  for  burial  and  $13  for  medical  aid. 
In  the  other  cases  compensation  at  half  the  average  wages  amounted 
to  $29.17,  $16.67,  and  $36,  respectively,  and  for  medical  aid  $33, 
$41.50,  and  $44  was  allowed. 

In  Pennsylvania  the  workmen's  compensation  law  of  1916,  similar 
in  intent  to  the  laws  of  New  York  and  New  Jersey,  provides  that "  the 
terms  'injury'  and  'personal  injury'  as  used  in  this  act  shall  be 
construed  to  mean  only  violence  to  the  physical  structure  of  the  body, 
and  such  disease  or  infection  as  naturally  results  therefrom."  When 
in  April,  1916,  a  claim  was  filed  with  the  workmen's  compensation 
board  on  the  part  of  a  hair  sorter1  who  had  contracted  anthrax, 
the  claim  was  disallowed,  as  the  examination  of  the  physician  "  dis- 
closed no  evidence  of  any  wound  or  cut  upon  the  person  of  the 
claimant  nor  did  the  investigation,  made  at  this  time,  discover  any 
unusual  incident  or  occurrence  that  had  happened  to  the  employee 
in  the  Course  of  his  employment.  The  claimant  also  admitted  that 
there  had  been  no  wound  or  other  unusual  incident." 

As  far  as  can  be  learned  no  other  State  has  yet  been  called  upon 
to  decide  a  compensation  claim  arising  from  anthrax,  but  probably 
the  outcome  would  be  the  same  as  in  New  York  and  New  Jersey. 
While  this  would  permit  indemnity  for  a  limited  number  of  cases — 
those  resulting  from  a  definite  physical  wound — such  a  policy  is 
far  from  just.  In  equity  to  sufferers  from  the  disease,  no  less  than 
from  the  standpoint  of  enlisting  the  full  interest  of  employers  in 
methods  of  preventing  infection,  all  cases  of  occupational  anthrax 
should  be  compensated  upon  the  same  terms  as  industrial  accidents, 

1  Working  in  a  tannery. 


CHAPTER  V. 
ANTHRAX  IN  EUROPE. 

In  Europe,  where  occupational  anthrax  has  been  a  matter  of  public 
moment  for  a  much  longer  period  than  in  the  United  States,  the  cam- 
paign against  it  has  been  pressed  with  a  consistency  and  vigor  not 
yet  displayed  in  this  country.  Among  legislators  and  administrative 
officials,  no  less  than  among  employers  and  physicians,  there  has  been 
keen  realization  of  the  dangers  of  the  scourge  and  of  the  urgency  of 
measures  for  its  eradication. 

PRIVATE  ACTIVITY. 

The  dramatic  acuteness  and  high  mortality  of  anthrax  have  led 
abroad  to  considerable  private  activity  for  its  study,  cure,  and  pre- 
vention. In  England,  Germany,  France,  and  Italy  influential  associ- 
ations of  manufacturers  have  interested  themselves  in  the  problem, 
while  scientific  societies  of  international  scope  have  cooperated  in 
the  campaign. 

ANTHRAX  INVESTIGATION  BOARD  FOR  BRADFORD  AND  DISTRICT. 

Since  in  England  the  manipulation  of  dangerous  kinds  of  wool  is 
practically  confined  to  the  West  Riding  of  Yorkshire,  the  chamber 
of  commerce  of  that  district,  at  a  joint  meeting  with  representatives 
of  labor  unions,  organized  in  1905  the  now  famous  Anthrax  Investiga- 
tion Board  for  Bradford  and  District.  The  purposes  of  this  organi- 
zation are  (1)  the  investigation  of  anthrax  generally;  (2)  the  more 
precise  determination  of  the  classes  of  wool  and  hair  in  connection 
with  which  the  danger  of  anthrax  arises;  and  (3)  the  discovery  of 
further  means  of  prevention.  The  investigation  is  carried  on 
through  inquiries  into  cases  of  anthrax,  and  samples  are  collected  of 
the  material  causing  the  infection.  .The  data  thus  obtained  are 
brought  to  the  knowledge  of  the  manufacturers.  The  board  has  en- 
gaged the  services  of  a  bacteriologist,  some  of  whose  duties  are 
(1)  the  examination  of  material  which  has  caused  outbreaks  of 
anthrax;  (2)  systematic  examination  of  samples  irrespective  of  any 
such  outbreaks;  (3)  studying  of  the  part  played  in  infection  by  the 
sand,  dirt,  and  organisms  present  in  the  material;  (4)  verification  of 
doubtful  cases  and  examination  of  material  submitted  by  physicians. 
Particularly  careful  study  is  given  to  the  urgent  question  of  disin- 
fecting raw  wool,  and  especially  to  the  removal  of  blood  clots  and 
bloodstained  fibers,  which  are  frequent  carriers  of  spores. 

42806°— Bull.  205—17 7  95 


96  BULLETIN   OF    THE   BTJKEATT    OF    LABOR   STATISTICS. 

In  order  to  secure  effective  results  a  large  and  representative  mem- 
bership was  considered  necessary.  The  board  is  therefore  composed, 
in  addition  to  the  bacteriologist,  the  honorary  consulting  chemist, 
and  the  secretary,  of  18  members,  elected  annually  from  among  the 
.  manufacturers,  the  members  of  the  Bradford  Chamber  of  Commerce, 
and  the  health  committee  of  the  Bradford  City  Council ;  occasionally 
representatives  of  organized  labor  are  included.  The  activity  of  the 
board  is  made  possible  chiefly  by  private  contributions,  the  majority 
of  contributors  being  employers,  although  labor  organizations  and 
occasionally  private  individuals  also  subscribe.  A  point  deserving 
special  mention  is  the  annual  subvention  of  $250  granted  for  several 
years  by  the  Home  Office,  which  in  1913  was  raised  to  $500. 

To  obtain  the  highest  possible  degree  of  efficiency  the  board  is  con- 
stantly seeking  the  cooperation  of  the  medical  profession.  Circulars 
are  distributed  inviting  physicians  to  send  in  information  of  each 
case  of  suspected  anthrax,  together  with  serum  or  blood  for  examina- 
tion. The  board  emphasizes  the  necessity  of  speedy  action  in  sus- 
pected cases  and  urges  particular  care  with  regard  to  bloodstained 
materials.  Its  statistics,  which  will  be  discussed  later,  are  excellent, 
and  the  educational  propaganda  which  it  carries  on  is  undoubtedly 
an  important  factor  in  the  antianthrax  campaign. 

GERMAN   EMPLOYERS'   MUTUAL   TRADE  ASSOCIATIONS. 

The  activity  of  the  German  manufacturers  has  taken  an  entirely 
different  form.  In  Germany  preventive  measures  are  introduced 
by  the  employers'  mutual  trade  associations  {Berufsgenossenschaften) 
in  those  trades  where  the  danger  of  anthrax  is  present.  These  asso- 
ciations are  organized  primarily  for  the  purpose  of  carrying  mutual 
workmen's  compensation  insurance.  Since  it  is  to  their  financial  ad- 
vantage to  have  as  few  industrial  accidents  as  possible,  the  activity 
of  these  associations  is  remarkably  effective,  aiming  at  the  pre- 
vention of  both  industrial  accidents  and  diseases.  The  employ- 
ers of  practically  all  industries  have  combined  into  such  associations 
and,  as  anthrax  is  compensated  as  an  industrial  injury,  the 
associations  for  the  leather,  wool,  hair,  and  brush  industries  have 
set  forth  carefully  worked  out  rules  based  on  the  latest  achieve- 
ments of  technical  and  sanitary  science.  These  rules  when  officially 
indorsed  have  the  force  of  law.  A  considerable  incentive  to  the  ob- 
servance of  these  rules  is  provided  in  the  cleverly  arranged  sliding 
scale  of  premiums  required  from  the  employer  and  based  on  the 
number  and  effectiveness  of  safeguards  introduced  in  his  factory; 
that  is,  the  more  attention  is  paid  to  disease  and  accident  prevention, 
the  lower  are  the  insurance  premiums  charged  the  owner  of  the 
establishment. 


ANTHRAX  AS  AN    OCCUPATIONAL  DISEASE.  97 

The  employers  conduct  the  accident  insurance  activity  of  the  trade 
associations,  but  in  order  to  elicit  the  fullest  cooperation  of  the 
workers  they  have  given  the  latter  a  voice  in  framing  the  safety 
and  sanitation  rules;  they  have  gone  even  further  and  have  made 
the  workers  responsible  for  compliance  with  those  rules  which  con- 
cern them.  The  value  of  personal  appeal  has  also  been  appreciated 
by  these  associations;  they  have  addressed  warnings  to  the  workers 
instructing  them  in  the  dangers  and  urging  precaution.  The  remark- 
able thoroughness  with  which  these  employers'  mutual  associations 
have  carried  out  their  tasks  has  placed  them  in  the  foreground  as 
powerful  factors  in  the  promotion  of  industrial  health  and  safety. 

ASSOCIATION   OF   FRENCH   MANUFACTURERS   FOR   THE   PREVENTION    OF   INDUS- 
TRIAL ACCIDENTS. 

The  idea  of  employers'  mutual  organization  for  the  purpose  of 
accident  prevention  has  found  application  in  other  countries  also.  In 
France  in  1883  the  manufacturers  combined  into  the  "  Association 
des  industrials  de  France  contre  les  accidents  du  travail,"  which  by 
a  Government  order  was  recognized  in  1891  as  a  public  service  or- 
ganization {Etablissement  cPutilite  publique)  -1  This  association  pub- 
lishes instructions  to  workers  similar  to  those  issued  by  the  Home 
Office  in  England  and  by  the  German  trade  associations,  and  re- 
quires that  they  be  posted  in  work  places  where  the  danger  of  anthrax 
is  present. 

MILAN  LABOR  CLINIC  AND  OTHER  PRIVATE  ACTIVITY  IN  ITALY. 

In  1910  the  celebrated  Labor  Clinic  at  Milan,  the  first  of  its  kind 
in  the  world,  was  established  by  a  group  of  socially  minded  medical 
men  "  for  the  scientific  study  and  prevention  of  occupational  dis- 
eases." In  cooperation  with  the  Permanent  International  Commis- 
sion for  the  Study  of  Occupational  Diseases,  which  has  its  head- 
quarters in  the  same  city,  the  clinic  has  issued  sanitary  regulations 
and  is  carrying  on  an  educational  propaganda  among  workers  and 
employers  in  the  industries  which  involve  exposure  to  anthrax. 
There  exists  in  Italy  also  the  Industrial  Employers'  Association  for 
the  Prevention  of  Industrial  Accidents  {Assodazione  degli  Indus- 
triali  per  prevenire  gli  Infortuni  del  Lavoro),  an  organization  very 
similar  to  the  French  association  which  has  already  been  described. 
This  body  issues  instructions  for  workers,  and  also  publishes  occa- 
sional studies  on  occupational  anthrax. 

A  notable  instance  of  self-imposed  but  rigidly  observed  regula- 
tions is  found  in  the  hair  works  of  Carlo  Pachetti  &  Co.,  at  Pavia. 
This  is  the  largest  establishment  of  its  kind  in  Italy,  and  it  re- 
ceives practically  all  the  hair  imported.    The  firm  is  equipped  with 

1  Walter  Abelsdorff :  Gewerbliche  Milzbrandvergiftungen  in  Deutschland,  Frankreich, 
England,  und  Holland,  1915,  p.  7. 


98  BULLETIN   OF    THE   BUBEATJ    OF    LAB  OB   STATISTICS. 

all  the  requisites  of  modern  industrial  hygiene,  and  has  adopted  the 
most  advanced  measures  for  the  prevention  of  anthrax.  Each 
process  is  carefully  regulated.  The  hair  is  disinfected ;  great  care  is 
given  to  ventilation,  cleanliness,  and  the  elimination  of  dust;  and 
medical  supervision  of  the  highest  order  is  instituted,  even  a  bac- 
teriological laboratory  being  provided  and  a  supply  of  the  Sclavo 
serum  being  kept.  The  proprietor  states  that  cases  of;  anthrax  are 
detected  in  the  earlier  stages  and  promptly  treated,  and  that  the 
patients  usually  recover  "  without  cessation  of  work  for  more  than 
a  day  or  two." x 

INTERNATIONAL   ORGANIZATIONS  AND   CONGRESSES. 

Anthrax  has  also  been  carefully  studied  outside  of  industry. 
Besides  the  Permanent  International  Commission  for  the  Study  of 
Occupational  Diseases,  already  mentioned,  both  international  con- 
gresses on  occupational  diseases  which  have  so  far  taken  place,  one 
at  Milan  in  1906  and  the  other  at  Brussels  in  1910,  have  discussed  the 
subject.  More  prominence  was  given  to  it  on  the  program  of  the 
proposed  third  congress  on  occupational  diseases,  which  was  scheduled 
for  Vienna  in  1914  but  was  postponed  on  account  of  the  war.  In  that 
congress,  papers  were  to  be  read  by  such  authorities  as  Dr.  Legge 
of  England,  Cavaille  of  France,  and  Dr.  Holtzmann  of  Germany. 
Keen  interest  is  also  taken  in  the  subject  by  the  International  Asso- 
ciation for  Labor  Legislation,  of  which  the  American  Association  for 
Labor  Legislation  is  an  active  branch.  At  the  seventh  delegates' 
meeting  of  the  international  body,  which  took  place  in  Zurich  Sep- 
tember 10  to  12,  1912,  a  subcommittee  was  appointed  for  the  study 
of  occupational  anthrax,  the  recommendations  of  which  will  be  found 
in  the  concluding  part  of  this  report.  The  subject  was  also  on  the 
program  of  the  eighth  delegates'  meeting,  which  was  expected  to 
meet  in  Bern  September  14  to  17,  1914. 

GOVERNMENTAL  INVESTIGATIONS. 

Probably  the  first  official  investigation  of  anthrax  was  made  in 
1842  in  France.  In  that  country  severe  epidemics  of,  the  disease 
among  animals  in  certain  districts  and  its  consequent  frequency 
among  human  beings  had  led  to  these  areas  being  called  "  champs 
maudits,"  or  cursed  fields.  The  investigation  was  undertaken  at  a 
time  when  medical  science  was  rather  primitive,  and  antedated  by 
eight  years  the  discovery  of  the  bacterium.  Hence  it  did  not  bring 
forth  any  considerable  results,  but  the  interest  of  the  Government  is 
significant.  In  later  years  the  question  of  anthrax  was  taken  up  by 
a  commission  on  industrial  hygiene  organized  under  the  Ministry  of 
Labor. 

1  See  C.  H.  W.  Page :  British  Industrial  Anthrax,  in  Journal  of  Hygiene,  December, 
1909,  p.  373. 


ANTHRAX   AS  AN    OCCUPATIONAL  DISEASE.  99 

In  England  the  initiative  against  anthrax  was  taken  by  Parlia- 
ment, where  this  subject  was  considered  as  early  as  1878.  In  the 
year  1880  the  Government,  alarmed  bj^  the  large  number  of  cases 
among  workers,  appointed  a  commission  to  study  the  situation.  In 
1893  another  official  investigation  was  undertaken.  These  efforts, 
however,  did  not  solve  the  problem,  and  in  the  year  1913  the  Home 
Office  considered  it  necessary  to  appoint  a  departmental  committee 
for  the  purpose  of  investigating  anthrax  in  the  textile  industries. 

In  Germany  the  Government  was  stirred  by  the  alarming  propor- 
tions which  the  disease  assumed  in  the  hair  factories  of  Nuremberg 
and  in  1894  an  investigation  was  ordered  all  over  the  Empire. 
Inquiries  on  a  more  limited  scale  had  been  made  as  early  as  1875. 

In  Belgium  anthrax  has  been  a  familiar  subject  for  many  years, 
but  it  was  not  until  1900  that  Government  interest  became  active. 
At  that  time  several  cases  occurred  in  an  important  tannery  and  the 
Government  ordered  the  medical  factory  inspectors  to  make  an 
investigation,  which,  at  first  limited  to  skin  and  hair  industries,  was 
afterwards  extended  to  all  other  occupations  subject  to  the  danger 
of  anthrax. 

Moved  to  action  by  the  number  of  anthrax  cases  reported  in  the 
tanning  industry  under  the  accident  compensation  law  of  1901,  the 
general  director  of  labor  in  Holland  also  ordered  a  painstaking 
investigation  of  that  industry,  the  report  of  which  was  published  in 
1913.1 

SYSTEMATIC  REPORTING  AND  RESULTANT  DATA. 

Illuminating  as  are  most  of  the  studies  just  mentioned,  they  cover 
only  limited  periods,  and  emphasize  the  necessity  for  more  thorough, 
continuous  collection  of  data.  This  has  been  sought  in  various  coun- 
tries;,  usually  through  the  enactment  of  compulsory  reporting  laws. 

GREAT  BRITAIN. 

Apparently  the  earliest  requirement  concerning  the  reporting  of 
inthrax  as  an  occupational  disease  is  found  in  section  29  of  the  Brit- 
ish Factory  and  Workshop  Act  of  1895,2  later  superseded  by  the 
similar  law  of  1901.3  Section  73  of  the  latter  act,  referring  to  dan- 
gerous and  unhealthf  ul  industries,  requires  every  medical  practitioner 
called  in  to  visit  a  patient  suffering  from  lead,  phosphorus,  arsenic, 
or  mercury  poisoning,  or  anthrax,  contracted  in  a  factory  or  work- 
shop, to  report  the  case  to  the  chief  inspector  of  factories  at  the  Home 
Office,  London.  For  every  notice  sent,  the  physician  receives  a  fee 
of  2s.  6d.   (61  cents),  while  failure  to  comply  with  the  law  makes 

1  Directie  van  den  Arbeid.     De  Looinijverheid  in  Nederland,  The  Hague.   1913. 

2  57   and   58   Vict.,   ch.   37. 
31  Edw.  VII,  ch.  22. 


100 


BULLETIN    OF    THE   BUREAU    OF    LABOR    STATISTICS. 


him  liable  to  a  fine  of  not  over  40s.  ($9.73).  Similarly  the  manager 
or  owner  of  the  factory  must  report  every  case  of  any  of  the  above- 
mentioned  diseases  to  the  inspector  and  to  the  certifying  surgeon  for 
the  district.  Upon  receipt  of  the  report  the  latter  must  visit  the 
patient  and  the  place  where  the  case  occurred  and  report  to  the  chief 
inspector. 

The  report  by  the  factory  management  must  cover  the  following 
points : 

1.  Name  of  establishment. 

2.  Name  and  address  of  proprietor. 

3.  Kind  of  work  done. 

4.  Nature  of  the  disease. 

5.  Name  and  address  of  the  patient. 

6.  Age  and  sex. 

7.  Precise  statement  as  to  occupation. 

In  the  report  of  the  factory  inspector  to  the  Home  Office,  which 
must  be  sent  within  seven  days  after  receipt  of  the  report  from  the 
certifying  surgeon,  the  sorts  of  suspected  wool,  hair,  bristles,  hides, 
or  skins  must  be  stated,  as  well  as  the  country  of  origin. 

For  the  first  few  years  but  a  small  number  of  cases  was  reported — 
only  114,  for  instance,  for  the  years  1896  to  1899,  inclusive.  Since 
that  date  reporting  has  been  more  complete,  and  larger  numbers  of 
cases  have  been  brought  to  official  attention. 

The  following  table  is  compiled  from  the  annual  reports  of  the 
chief  factory  inspector  of  Great  Britain  and  shows  the  number  of 
cases  of  anthrax  reported  to  that  official  for  the  years  1900  to  1913 
and  the  number  of  these  cases  which  were  fatal : 


Table  9.— CASES  OF  ANTHRAX  AND  NUMBER  OF  DEATHS  THEREFROM  REPORTED 
TO  CHIEF  FACTORY  INSPECTOR  OF  GREAT  BRITAIN,  1900  TO  1913,  BY  INDUSTRIES 
AND  YEARS. 


[Source: 'Seventeenth  Abstract  of  Labor  Statistics  of  the  United  Kingdom 

1915,  pp.  124,  125.] 

Wool  industry. 

Horsehair. 

Skins  and 
hides. 

Other 
industries. 

Total. 

Year. 

Cases 

re- 
ported. 

Deaths 

re- 
ported. 

Cases 

re- 
ported. 

Deaths 

re- 
ported. 

Cases    Deaths 

re-          re- 
ported, ported. 

Cases 

re- 
ported. 

Deaths 

re- 
ported. 

Cases 

re- 
ported. 

Deaths 

re- 
ported. 

1900 

1901 

9 
6 
12 
20 
12 
34 
24 
23 
18 
28 
28 
35 
31 
43 

2 
4 
2 
5 
1 

12 
8 
3 
3 
3 
3 

10 
6 
4 

12 
9 
10 
7 
12 
7 
10 
17 
10 

3 
1 
2 

1 
4 
1 
5 
4 

9 

20 
11 
12 
18 
17 
18 
12 
13 
18 
14 

1 
5 
5 
1 
3 
4 
5 
2 
1 
6 
3 

7 
4 
5 
8 
8 
1 
14 
6 
6 
2 
3 
1 
1 
3 

1 

5 
2 
1 
3 
2 
3 
1 
2 

37 
39 
38 
47 
50 
59 
66 
58 
47 
56 
51 
64 
47 
70 

7 
10 

1902 

9 

1903 

12 

1904  

10 

1905 

18 

1906  

21 

1907 

11 

1908 

7 

1909 

8 

"     2 

12 

1910 

6 

8 
7 
5 

1 
1 

1 

9 

1911 

20 

11 

1912 

8 
19 

2 

6 

1913 

7 

Total 

323 

66 

128 

26 

209 

38 

69 

20 

729 

150 

ANTHRAX  as  ax  occupational  disease. 


101 


These  data  show  a  marked  though  irregular  increase  in  the  number 
of  cases  reported,  which  appears  rather  unexpected  in  view  of  the 
several  preventive  measures  introduced  during  that  period.  The 
increase,  however,  may  be  due  not  to  the  lack  or  ineffectiveness  of 
protective  legislation,  but  to  more  extensive  use  of  dangerous  mate- 
rials or  to  a  more  satisfactory  compliance  with  the  notification  law. 
Probably  the  fact  that  the  TV  orkmen's  Compensation  Act  of  1906 1 
made  anthrax  a  compensable  disease  has  had  much  to  do  with 
securing  fuller  reports.  As  will  be  seen  from  the  table,  the  frequency 
of  anthrax  varies  considerably  in  the  different  industries.  It  is 
significant  that  in  11  of  the  14  years  for  which  the  data  are  given 
the  largest  number  of  cases  occurred  in  the  wool  industry,  which  is 
more  developed  in  England  than  any  of  the  other  industries  subject 
to  anthrax.  In  6  of  these  11  years,  also;  one-half  or  more  of  the  total 
cases  of  anthrax  reported  each  year  occurred  in  that  industry.  Next 
in  the  prevalence  of  anthrax  is  the  leather  industry.  Practically 
all  industrial  cases  of  the  disease  occur  among  workers  in  the  wool 
and  leather  industries  and  in  animal-hair  works;  in  the  remaining 
occupations  anthrax  is  less  frequent. 

An  important  element  in  anthrax  statistics  is  the  death  rate.  A 
high  rate  may  mean  absence  of  curative  measures,  or  it  may  mean 
lack  of  familiarity  with  the  symptoms  of  the  disease,  which  prevents 
early  diagnosis  and  postpones  treatment  to  a  stage  when  cure  is  no 
longer  possible.  The  death  rate  for  the  seven  years  1900  to  1906  was 
25.9  per  100  cases;  but  a  marked  improvement  took  place  in  the 
subsequent  similar  period,  when  it  was  only  16  per  cent. 

More  detailed  statistics  are  available  for  the  wool  industry  of  the 
West  Riding  of  Yorkshire,  which  is  under  the  supervision  of  the 
anthrax  investigation  board  organized  for  that  district.  The  fol- 
lowing table  illustrates  the  situation  in  that  industry : 


Table  10.— CASES  OF  ANTHRAX  IN  THE  WOOL  INDUSTRY  REPORTED  TO  THE  AN- 
THRAX INVESTIGATION  BOARD  FOR  BRADFORD  AND  DISTRICT,  1906  TO  1914. 

[Compiled  from  annual  reports  of  the  Anthrax  Investigation  Board  for  Bradford  and  District.!) 


Year  ending 
Oct.  31— 

Cases  reported. 

Deaths 
reported. 

1 
External.  Internal. 

Total. 

1907 

U    ,             1 

i?  1      ! 

12      

12 
10 
18 
12 
19 
18 
21 
18 
16 

3 
3 
2 

1 
8 
5 

! 

2 

1908 

1909 

1910 

1911 

14  j              5 

15  3 
20    1              1 
18      

1912 

1913 

1914 

1915 

14                  2 

Total . . . 

129     ,            15 

144 

32 

*6  Edw.  VII,  ch.  47,  third  schedule. 


102  BULLETIN   OF    THE   BUREAU    OF    LABOR   STATISTICS. 

Comparison  of  these  data  with  the  data  for  the  wool  industry  of 
the  whole  country  for  the  almost  exactly  corresponding  period  of 
1906  to  1913  shows  that  more  than  one-half  of  the  anthrax  cases  in 
this  industry  occur  in  the  district  of  the  West  Riding.  The  high  fre- 
quency of  anthrax  in  that  district  is  caused  by  the  use  of  wool  im- 
ported from  such  countries  as  Persia,  Turkey,  India,  and  Russia, 
where  anthrax  is  endemic  and  where  very  little  or  no  attention  is 
given  to  the  requirements  of  hygiene. 

GERMANY. 

In  another  leading  European  country,  Germany,  where  consider- 
able attention  is  being  given  to  the  subject  of  anthrax,  fairly  com- 
plete data  are  obtainable,  but  only  for  the  last  few  years.  For  the 
years  1894  to  1903  admittedly  incomplete  statistics  are  reported  by 
Dr.  Legge.1  He  states  that  in  that  period  there  were  901  cases  of 
anthrax,  including  those  in  agriculture  as  well  as  in  manufacturing, 
of  which  128  were  fatal. 

A  great  improvement  in  the  collection  of  information  was  brought 
about  in  1910,  when  an  order  of  the  Federal  Council  went  into  effect, 
extending  to  anthrax  the  notification  and  other  provisions  of  the 
act  of  1900  relative  to  diseases  constituting  a  public  menace. 

Besides  the  usual  data  as  to  name,  sex,  age,  address,  and  occupa- 
tion, the  following  information,  important  from  the  medical  point  of 
view,  must  be  given : 

1.  Date  when  taken  ill. 

2.  Date  of  first  medical  treatment. 

3.  Date  of  admission  to  a  hospital. 

4.  Date  when  the  disease  was  diagnosed  by  the  doctor  as  anthrax. 

5.  Was  the  disease  bacteriologically  recognized  as  anthrax?  When? 
By  whom? 

6.  Nature  of  the  disease :  Anthrax  of  the  lungs,  anthrax  of  the 
bowels,  anthrax  of  the  skin?  If  anthrax  of  the  skin,  what  part  of 
the  body  was  affected? 

7.  Has  the  sick  person  recovered  ?    Has  he  died  ?    When  ? 

Even  more  minutely  are  taken  up  the  questions  of  the  patient's 
occupation  and  of  the  manner  in  which  infection  was  transmitted. 
The  method  of  filling  out  the  schedule  calls  for  cooperation  between 
several  governmental  agencies,  namely,  the  police  authorities,  the 
district  medical  man  or  veterinary  surgeon,  and  the  factory  inspec- 
tor. A  duplicate  of  the  filled-in  schedule  is  sent  to  the  authority  in- 
trusted by  the  provincial  government  with  its  verification.  Upon 
verification  a  copy  is  transmitted  to  the  Imperial  Health  Office  at 
Berlin,  where  it  must  be  received  within  two  weeks  of  recovery  or 
death  of  the  patient. 

iT.  M.  Legge,  in  The  Lancet,  Mar.  18,  1905,  p.  692. 


ANTHEAX   AS   AX    OCCUPATIONAL   DISEASE, 


103 


The  statistics  obtained  under  this  law  are  publisher  annually  and 
are  of  more  interest  than  the  English  figures  because  they  include  all 
cases,  nonoccupational  as  well  as  occupational.  Up  to  the  present, 
figures  are  available  only  for  the  years  1910  to  1912. 

Table   11.— CASES  OF    ANTHRAX   REPORTED   TO   THE   IMPERIAL    HEALTH  OFFICE 

OF  GERMANY,  1910  TO  1912. 

[Compiled  from  Reichs-Arbeitsblatt,  July,  1914,  p.  588.] 


1910 

1911 

1912 

Industry. 

Cases 
report- 
ed. 

Deaths 
report- 
ed. 

Deaths 
per  100 
cases. 

Cases 
report- 
ed. 

Deaths 
report- 
ed. 

Deaths 
per  100 
cases. 

Cases 
report- 
ed. 

Deaths 
report- 
ed. 

Deaths 
per  100 
cases. 

121 

14 

103 
15 
1 

9 

12 

142 

16 

75 
19 

16 

1 

10 
4 

114 

17 

78 
21 

10 
1 

I 

Cattle  dealers,  veterinarians, 

Tannery  and  other  leather 

19 
3 

Hair  and  brush  workers 

2| 

9 

5 



16 

6 

Total  occupational 

263 

36 

13.7 

261 

36 

13.8 

246 

28 

11.4 

Total  anthrax 

287 

40 

13.9 

281 

40         14.2 

274 

36 

13.1 

Taking  the  cases  in  the  last  four  groups  as  those  of  anthrax  in 
manufacturing  pursuits,  we  obtain  for  the  year  1910,  128  such  cases ; 
for  1911,  103  cases ;  and  for  1912,  115.  A  comparison  of  the  individ- 
ual occupations  shows  that  agriculture,  followed  by  the  leather  in- 
dustry, heads  the  list  in  each  of  the  three  years.  The  death  rate  is 
somewhat  higher  than  that  shown  by  the  English  figures  (17.6, 
17.2,  and  12.8)  for  the  corresponding  years;  it  is  also  higher  for 
the  nonoccupational  group  than  for  the  occupations,  which  is  true 
in  other  countries  also.  This  is  explained  by  the  comparative  in- 
frequency  of  nonoccupational  anthrax  and  consequent  lack  of  fa- 
miliarity with  the  symptoms  on  the  part  of  the  victims  and  their 
physicians. 

Owing  to  the  brief  period  covered  by  the  data  no  conclusions  can» 
be  drawn  as  to  fluctuations  in  the  prevalence  of  the  disease,  but  the 
situation  in  the  leather  industry  is  worth  noting.  The  number  of 
cases  dropped  from  103  in  1910  to  75  in  1911,  and  to  78  in  1912. 
This  was  probably  due  to  the  effective  preventive  regulations  for 
that  industry  which  went  into  effect  in  the  latter  part  of  1910. 

The  distribution  by  sex  of  all  cases  reported  in  the  three  years 
was  as  follows : 


Year. 

Males. 

Females. 

Total. 

1910 

257 

30 

287 

1911 

264 

17 

281 

1912 

254 

20 

274 

104 


BULLETIN"   OF    THE   BUREAU    OF    LABOR   STATISTICS. 


The  small  number  of  cases  among  women  is  explained  by  their 
more  limited  employment  in  the  occupations  subject  to  anthrax. 

FRANCE. 

In  France,  also,  anthrax  statistics  are  of  a  very  recent  origin. 
They  are  now  being  collected  as  a  result  of  the  ministerial  order  of 
July  20,  1910,  but,  as  in  England,  only  cases  of  industrial  anthrax 
are  included.  For  the  years  1910  to  1912  the  cases  reported  were 
distributed  among  the  industries  as  follows: 

TABLE  13.— CASES  OF  ANTHRAX  REPORTED  IN  FRANCE,  1910  TO  1912. 
[Compiled  from  Reichs-Arbeitsblatt,  July,  1914,  p.  589.] 


Industry. 

1910 

1911 

1912 

36 
10 

4 

4 

23 
7 
3 
9 

22 
6 
5 
5 

Wool 

Other 

Total 

54 

42 

38 

According  to  sex  the  cases  were  distributed  as  follows : 


Year. 

Males. 

Females. 

Total. 

1910 

39 

15 

54 

1911 

35 

7 

42 

1912 

29 

9 

38 

HOLLAND. 

Until  1905,  when  it  was  decided  that  workmen  suffering  from 
anthrax  should  receive  indemnity  in  accordance  with  the  workmen's 
compensation  act,  there  was  no  obligation  upon  either  employers, 
patients,  or  physicians  to  report  cases  of  the  disease.  Nevertheless, 
subsequent  inquiry  in  North  Brabant,  the  principal  seat  of  the  Dutch 
tanning  industry,  yielded  the  following  data : 

Table  13.— CASES  OF  HUMAN  ANTHRAX  REPORTED  IN  HOLLAND,  1898  TO  1911. 
[Source:  Direccie  van  den  Arbeid.    De  Looinijverheid  in  Nederland,  The  Hague,  1913,  p.  115.] 


Year. 

Total 
cases 
re- 
ported. 

Cases 
among 
tanners. 

Fatal 

cases. 

Year. 

Total 
cases 
re- 
ported. 

Cases 
among 
tanners. 

Fatal 

cases. 

1898 

2 
1 
2 

2 
1 
2 

1906  

5 
9 
5 
9 
5 
3 

5 
9 
4 
8 
5 
3 

1899 

1907 

1 

1900 

1 

1908 

1901 

1909 

1 

1902 

2 

2 

1910 

1903 

1911 

2 

2 
2 

Total 

1905 

1 

47 

45 

4 

ANTHRAX   AS   AN    OCCUPATIONAL   DISEASE. 


105 


The  influence  of  the  compensation  law  in  encouraging  the  report- 
ing of  cases  is  clearly  seen  in  the  figures  for  the  later  years.  The 
general  director  of  labor  estimates  that  in  the  tanning  industry  there 
are  annually,  per  1,000  workmen,  4.7  cases  of  infection  and  0.3  deaths. 

In  1911  a  new  labor  code  was  enacted,  section  21  of  which  requires 
the  reporting  of  occupational  diseases.  The  reports  are  to  be  sent  to 
the  general  director  of  labor  within  eight  days  of  the  diagnosis.  For 
each  report  a  fee  of  22  cents  is  paid,  and  a  fine  of  $20  is  provided  for 
failure  to  comply  with  the  law.  The  report  is  made  according  to  a 
prescribed  form,  giving  name,  sex,  age,  and  residence  of  the  patient, 
also  the  diagnosis,  nature  of  establishment,  kind  and  duration  of 
work,  and  other  necessary  data.  An  interesting  educational  section 
of  the  law  requires  the  doctor  to  have  a  manual  describing  the 
causes  and  symptoms  of  each  disease  to  which  the  statute  applies,  as 
well  as  the  occupations  in  which  the  disease  may  occur. 

For  the  year  1912,  16  cases  of  industrial  anthrax  were  reported, 
7  of  which  occurred  among  brush  workers.1  These  figures  are  prob- 
ably incomplete,  as  is  usually  the  case  with  data  obtained  for  the  first 
year  of  the  operation  of  a  law. 


ITALY. 


Data  for  Italy,  where  anthrax  is  reportable  as  an  infectious  dis- 
ease, show  tremendous  prevalence  of  the  disease.  Sclavo  gathered, 
from  1880  to  1890,  records  of  24,052  cases  among  human  beings,  of 
which  5,812  were  fatal.  These  figures  are  carried  down  to  the  end 
of  1904  in  the  following  table : 


Table  14.— RECORDED  CASES  OF  HUMAN  ANTHRAX  IN  ITALY,  1890  TO  1904. 
[Source:  C  H.  W.  Page,  British  Industrial  Anthrax,  In  Journal  of  Hygiene,  November,  1909,  p.  291.] 


Year. 

Cases. 

Deaths. 

Deaths 
per  100 
cases. 

Year. 

Cases. 

Deaths. 

Deaths 
per  100 
cases. 

1890             _    

2,047 
2,241 
2,077 
2,461 
2,400 
2,179 
1,985 
2,123 
2,327 

526 
645 
650 
598 
635 
621 
453 
460 
433 

25.7 
28.8 
31.3 
24.3 
26.5 
28.5 
22.8 
21.7 
18.6 

1899___ 

2,672 
1,867 
1,992 
3,528 
3,423 
3,104 

461 
330 
341 
403 
397 
355 

17.3 

1891 

1900-.     

17.7 

1892 

1901 

17.1 

1893 

1902      

11.4 

1894    _          _     — 

1903 

1904 

Total.... 

11.6 

1895        

11.4 

1897 

36, 426 

7.30S 

20.1 

1898- 

1  Walter   Abelsdorff :    Gewerbliche   Milzbrandvergiftungen    in    Deutschland,    Frankreich, 
England,  und  Holland,  1915,  p.  9. 


106  BULLETIN    OF    THE   BUREAU   OF   LABOR   STATISTICS. 

For  later  years  the  data  have  been  published  irregularly,  but  the 
following  are  obtainable : 1 

Year.  Cases. 

1905 2,  893 

August-December,  1908 2, 188 

1909 -_ 2,  736 

1910 2,  252 

January-May,  1911 364 

Most  of  these  cases,  it  should  be  said,  arise  in  the  nonmanufac- 
turing  districts. 

RUSSIA. 

In  Russia  epidemics  of  the  malady  are  common,  under  the  name 
"  Siberian  pest,"  528  persons  having  died  of  it  from  1867  to  1870  in 
the  single  Province  of  Novgorod.  Javorsky  is  authority  for  the 
statement  that  in  the  whole  country  more  than  10,000  cases  are  annu- 
ally observed.  Even  this  appalling  figure  would  seem  to  be  too  low, 
for  Popov 2  declares  that  in  the  years  1901  to  .1908,  inclusive,  there 
were  80,498  cases,  or  more  than  16,000  a  year.  As  in  Italy,  however, 
it  is  believed  that  the  majority  of  cases  occur  outside  of  the  manu- 
facturing industries. 

The  data  for  other  European  countries  are  even  less  reliable.  In 
Austria  the  law  of  April  14,  1913,  made  human  anthrax,  among 
several  other  infectious  diseases,  reportable.  Earlier  reports  of  the 
factory  inspectors  give  the  following  data  for  the  years  1903  to 
1906:  1903,  15  cases;  1904,  5  cases;  1905,  13  cases;  1906,  4  cases. 

These  fluctuations,  however,  seem  improbable,  and  the  figures  as 
a  whole  appear  to  be  too  low,  for  in  the  report  for  1907  a  factory 
inspector  stated  that  in  the  brush  factories  of  his  district  alone  50 
cases  of  anthrax  had  occurred  in  the  preceding  10  years. 

PROTECTIVE  LEGISLATION. 

Absolute  prohibition  of  the  importation  of  animal  materials  from 
countries  where  anthrax  is  known  to  exist,  unless  such  materials  are 
first  thoroughly  disinfected,  would  probably  put  an  effective  stop  to 
the  ravages  of  the  malady  among  industrial  workers.  No  country, 
however,  has  yet  found  such  a  step  either  commercially  or  adminis- 
tratively possible.  Many  of  them — France,  Germany,  Great  Britain, 
Holland,  Hungary,  Italy,  and  Spain,  for  instance — do  prohibit  the 
emplojrment  of  women  or  of  children  of  different  ages  in  dangerous 
processes,  but  the  great  mass  of  European  legislation  on  occupational 
anthrax  is  confined  to  more  or  less  careful  general  regulation  of  the 
hazardous  trades  and  occupations. 

1  Compiled  from  Rivista  di  Igiene  e  di  Sanita  Publica. 

aH.   B.   Popov:    Russki   Vratch    [The   Russian    Physician],    June    14,    1914,    p.    S48. 


ANTHKAX   AS   AN    OCCUPATIONAL  DISEASE.  107 

WOOL,   HAIR,  AND   BRISTLES. 


Of  the  industries  in  which  there  is  danger  of  anthrax,  those  which 
involve  the  handling  of  wool,  hair,  and  bristles  have  been  most 
widely  and  thoroughly  brought  under  Government  regulation. 

In  England  the  wool  industry  has  reached  a  high  degree  of  devel- 
opment, and  much  of  its  raw  material  comes  from  Persia,  East  India, 
China,  and  other  countries  where  anthrax  is  endemic  and  precau- 
tionary measures  are  almost  unknown.  Its  attention  having  been 
drawn  by  the  frequency  of  anthrax  among  wool  sorters,  the  English 
Government  called  in  1884  a  conference  of  public  health  officials, 
representatives  of  the  workers,  and  wool  merchants.  At  this  con- 
ference the  first  tentative  set  of  regulations  for  the  wool  industry  was 
adopted.  In  1897  instructions  were  published  for  wool-sorting  and 
in  1900  for  wool-dyeing  establishments. 

In  1905  the  Home  Office  issued  regulations  which  codified  and 
amplified  the  earlier  rules.  They  refer1  to  the  work  of  sorting, 
"  willeying  "  (willowing),  washing,  combing,  and  carding  wool,  goat 
hair,  and  camel  hair,  and  the  incidental  processes.  Only  certain 
specified  materials,  imported  chiefly  from  Asiatic  countries,  come 
under  these  regulations.  Detailed  instructions  are  given  for  the 
opening  and  handling  of  wool  or  hair.  Each  bale  may  be  opened 
only  after  it  has  been  thoroughly  steeped  in  water  and  only  by  men 
skilled  in  judging  the  condition  of  the  material;  screens,  sorting 
boards,  and  willowing  machines  of  specified  construction  are 
required.  Several  kinds  of  materials  must  not  be  sorted  except  in  a 
damp  state  and  after  being  washed.  Goods  must  be  stored  only  in 
places  set  apart  for  the  purpose.  Detailed  regulations  are  set  forth 
for  ventilation,  cleanliness,  disposal  of  waste,  working  clothes,  and 
requisites  for  treating  scratches  and  slight  wounds.  Strict  require- 
ments apply  to  the  places  where  unwashed  wool  or  hair  of  the  kinds 
named  is  handled  or  stored.  For  persons  working  in  those  rooms 
there  must  be  sufficient  washing  accommodations,  with  soap,  nail- 
brushes, and  towels,  and  proper  places  for  keeping  food  and  clothing. 
A  worker  having  an  open  cut  or  sore  must  not  be  employed  in  any 
such  room. 

The  regulations  prescribed  for  the  employers  are  followed  by 
instructions  to  the  workers,  who  are  also  made  responsible  for  com- 
pliance with  the  rules.  Attached  to  the  regulations  is  a  note  describ- 
ing the  dangers  of  anthrax  and  urging  personal  cleanliness. 

These  regulations  apply  only  to  the  more  dangerous  kinds  of 
wool,  and  therefore  protect  only  part  of  the  woolworkers  of  the 
United  Kingdom;  all  other  kinds  of  wool  are  disregarded,  as,  for 
instance,  those  coming  from  South  Africa  and  South  America,  which 

iSee  pp.   137-140. 


108  BULLETIN    OF    THE   BUREAU    OF    LABOR   STATISTICS. 

are  not  classified  as  "  dangerous."  but  which  also  cause  anthrax, 
although  less  frequently  than  the  materials  mentioned  by  the  regula- 
tions. The  insufficiency  of  the  regulations  is,  indeed,  generally  agreed 
upon,  and  revision  is  now  being  considered  by  the  departmental 
committee  on  anthrax. 

Prevention  of  anthrax  in  the  trades  using  the  coarser  kinds  of  hair 
was  not  taken  up  by  the  British  Government  until  several  years 
later,  probably  because  the  danger  was  less  conspicuous  than  in  the 
wool  industry.  Processes  involving  the  use  of  horsehair  from 
China,  Siberia,  or  Russia  were  made  subject  to  regulation  in  1908.1 
These  countries  are  specified  because  hair  shipped  from  there  is  con- 
sidered particularly  dangerous.  These  rules  contain  for  the  first 
time  the  significant  requirement  of  disinfection,  which  may  be  car- 
ried out  by  steam  or  by  any  other  method  certified  by  a  Government- 
recognized  laboratory.  Rules  are  also  set  forth  for  the  opening, 
sorting,  and  storing  of  nondisinfected  material,  exhaust  drafts  of 
a  prescribed  kind  are  required,  and  instructions  are  given  for  the 
disposal  of  dust  collected  during  the  various  processes.  The  require- 
ments with  regard  to  working  clothes,  respirators,  supplies  for  treat- 
ing wounds,  cloak  and  lunch  rooms,  and  lavatories  are  similar  to 
those  contained  in  the  regulations  for  work  on  wool.  As  in  those 
regulations,  also,  the  workers  are  called  upon  to  observe  the  pre- 
scribed rules.  An  important  factor  in  the  success  of  these  measures 
is  the  provision  which  imposes  a  penalty  not  only  upon  the  recal- 
citrant employer  but  also  upon  the  worker  who  fails  to  observe  the 
law.  This  provision  is  found  in  section  85  (2)  of  the  Factory  and 
Workshop  Act  of  1901 :  "  If  any  person  other  than  an  occupier, 
owner,  or  manager,  who  is  bound  to  observe  any  regulations  under 
this  act,  acts  in  contravention  of,  or  fails  to  comply  with  the  regula- 
tions, he  shall  be  liable  for  each  offense  to  a  fine  not  exceeding  £2 
[$9.73]." 2- 

In  Germany  industrial  anthrax  appears  to  be  particularly  preva- 
lent among  hair  and  brush  workers,  and  detailed  legislation-  for  that 
industry  was  secured  fairly  early.  The  question  is  taken  up  by  an 
order  of  the  Federal  Council  of  October  22,  1902,3  which  superseded 
a  similar  order  of  January  28,  1899.  The  German  order  agrees  in 
its  main  points  with  the  British  regulations.  Both  require  disinfec- 
tion of  materials,  isolation  of  nondisinfected  goods,  special  working 
clothes,  and  dressing  rooms  and  lunch  rooms  for  the  workers  who 
come  in  contact  with  raw  products.  Factory  sanitation  and  personal 
hygiene  are  also  prescribed  along  similar  lines.  But,  contrary  to 
the  English  law,  the  German  decree  applies  not  only  to  goods  coming 

1  Appendix  B,  p.   141.  2I  Edw.  VII,  ch.  22.  3  See  Appendix  B,  p.   145. 


ANTHRAX   AS  AN    OCCUPATIONAL   DISEASE.  109 

from  certain  countries  but  to  all  horse,  cattle,  and  goat  hair  and  pigs' 
bristles  of  foreign  origin.  It  also  differs  from  the  English  law  in 
several  other  important  points.  For  instance,  public  disinfection 
stations  are  established,  indicating  great  interest  on  the  part  of  the 
Government.  The  employer  is  required  to  furnish  the  workers  facili- 
ties for  warm  bathing  twice  a  week  and  to  see  that  each  individual 
wears  the  working  clothes  assigned  to  him.  Perhaps  the  most  sig- 
nificant provision  is  that  allowing  the  employer  to  discharge  without 
notice  and  without  liability  for  breach  of  contract  any  worker  who, 
after  repeated  warning,  persists  in  violating  the  rules.  In  addition 
to  its  salutary  disciplinary  effect  upon  the  employee,  this  provision 
is  of  considerable  consequence  in  a  country  like  Germany  where 
anthrax  is  compensated  as  an  industrial  injury,  as  it  safeguards  the 
employer's  financial  interests  against  the  employee's  possible  care- 
lessness. 

French  regulations  for  the  prevention  of  anthrax  in  the  industries 
under  discussion  are  contained  mainly  in  the  decree  of  October  1, 
1913, x  which  superseded  all  earlier  laws.  This  decree,  like  its  prede- 
cessors of  1908  and  1910,  does  not  follow  the  English  or  German 
method  of  special  regulations  for  each  industry  or  allied  group  of 
industries,  but  applies  to  all  establishments  in  which  the  employees 
are  menaced  by  anthrax,  including  those  "  where  skins,  fur,  horsehair, 
hogs'  bristles,  wool,  horns,  or  bones,  or  other  animal  products  liable  to 
be  infected  "  are  handled.  Special  attention  is  given  to  the  protection 
of  workers  engaged  on  nondisinfected  material  or  on  the  process 
of  disinfection.  The  methods  of  disinfection  used  must,  as  in  Eng- 
land and  Germany,  be  officially  approved.  The  rules  referring  to 
sanitation  in  the  work  place,  working  clothes,  dressing  rooms,  lava- 
tories, and  personal  cleanliness  are  very  similar  to  those  prescribed 
by  the  two  countries  already  discussed,  but  lack  their  minuteness  and 
definiteness.  Walls,  floors,  tables,  and  benches,  for  instance,  must 
be  washed,  not  at  definitely  stated  intervals,  but  "  whenever  neces- 
sary," or  "  as  often  as  may  be  necessary,"  and  must  be  "  frequently  " 
disinfected.  The  vital  matter  of  dust  prevention,  which  is  taken  up 
with  considerable  care  in  England  and  Germany,  has  received  little 
thought  from  the  French  authorities.  Instead  of  requiring  dust- 
removing  devices  the  law  simply  states  that  wool,  horsehair,  other 
animal  hair,  and  bristles  must  be  handled,  "  whenever  possible,"  in 
closed  vessels.  If  this  is  impracticable,  as  for  instance,  in  the  case 
of  opening  bales  or  beating,  the  operations  must  be  carried  out 
"  under  such  conditions  as  will  allow  the  collection  of  all  offal  and 
its  subsequent  destruction." 

1  See  Appendix  B,  p.  143. 


110  BULLETIN"   OF   THE  BUREAU   OF   LABOR  STATISTICS. 

Another  preventive  dev.'.ce  which  escaped  the  attention  of  the 
French  lawmakers  is  that  of  imposing  some  responsibility  upon  the 
workers.  Overalls  and  respirators  provided  tty  the  firm  can  not 
serve  their  purpose  unless  they  are  worn,  and  the  best  equipped 
lavatories  and  dressing  rooms  are  useless  if  the  worker  ignores  them. 
Consequently,  pressure  must  be  exercised  not  only  on  the  employer 
but  on  the  worker  also.  French  employees,  however,  are  merely 
asked,  through  regulations  posted  in  the  workroomSj  to  use  the  vari- 
ous working  articles  provided  for  them,  as  well  as  the  washstands 
and  dressing  rooms,  to  clean  themselves  before  leaving  the  premises, 
and  to  bring  no  food  into  the  workrooms. 

In  Hungary  workers  in  brush  factories  and  in  all  establishments 
where  horse  and  cattle  hair  and  pigs'  bristles  are  manipulated  are 
protected  against  anthrax  by  an  order  of  the  minister  of  commerce, 
issued  on  May  18,  1903.  This  order  is  practically  the  same  as  the 
order  of  the  German  Federal  Council  of  October  22,  1902. 

The  majority  of  cases  of  anthrax  in  Belgium  have  occurred  among 
brush  workers,  and  this  circumstance  prompted  the  royal  order  of 
August  20,  1908.  In  striking  contrast  to  the  previously  discussed 
legislation,  this  order  consists  of  only  two  short  sections  and  merely 
prescribes,  imperatively,  the  disinfection  of  hair  in  a  manner  "  suffi- 
cient to  kill  the  anthrax  spore."  Medical  inspectors  are  to  test, 
through  samples  of  disinfected  hair,  the  effectiveness  of  the  method 
used. 

HIDES   AND   SKINS. 

Another  large  group  of  industries  in  which  the  need  of  Govern- 
ment activity  against  anthrax  has  been  felt  by  several  European 
countries  is  that  connected  with  hides  and  skins,  especially  in  the 
processes  of  tanning.  The  problem  of  infection  from  imported  hides 
and  skins  was  taken  up  in  Great  Britain  in  1899.  In  1901  rules  were 
published  by  the  Home  Office  for  establishments  using  dry  and  dry- 
salted  hides  and  skins  imported  from  China  or  from  the  west  coast 
of  India.1  It  was  required  that  provision  be  made  for  overalls  and 
gloves,  for  the  keeping  of  food  and  clothing,  for  washing  accom- 
modations, and  for  the  dressing  of  wounds.  Notes  are  added  to 
the  rules,  one  calling  the  worker's  attention  to  the  dangers  of  an- 
thrax, and  another  reminding  him  of  his  obligation  to  observe  the 
law. 

Prussian  workers  engaged  on  imported  hides  and  skins  are  covered 
by  a  ministerial  order  issued  on  May  9,  1902.  It  briefly  describes  the 
nature  of  anthrax  and  its  danger  to  the  worker  and  emphasizes  the 
necessity  of  precautionary  measures.2 

1  See  Appendix   B,   p.   136.  2  See   Appendix   B,   p.    148. 


ANTHRAX   AS  AN"   OCCUPATIONAL  DISEASE.  Ill 

A  later  and  more  effective  measure  was  the  decree  of  the  Prussian 
minister- of  commerce  dated  December  20,  1910.  This  directs  factory 
managers  to  adopt  for  the  protection  of  tanners  the  regulations  issued 
by  the  Leather  Trade  Association,  which  were  based  on  the  latest 
scientific  investigations  and  were  framed  in  conformity  with  the  re- 
quirements of  the  Imperial  Health  Office.1  The  rules  apply  to  raw 
sheep  and  goat  skins  and  to  all  skins  and  hides  imported  in  a  dry, 
raw  state.  These  materials  must  be  kept  in  isolated  storerooms. 
Detailed  rules  are  prescribed  for  the  sanitation  of  the  storerooms 
and  for  the  transportation  and  handling  of  the  goods.  The  familiar 
instructions  with  regard  to  working  clothes,  lavatories  and  lunch- 
rooms are  also  found,  as  well  as  an  interesting  rule  forbidding  the 
worker  to  enter  the  lunch  room,  to  eat  any  food,  or  to  leave  the 
premises  until  he  has  changed  his  working  clothes  and  has  thoroughly 
washed  the  face,  head,  hair  and  beard,  neck,  hands,  and  arms.  Each 
new  worker  receives  a  copy  of  regulations  for  the  prevention  of 
accidents,  and  instructions  concerning  anthrax. 

Other  States  of  the  German  Empire  have  also  accepted  these  regu- 
lations. Stuttgart,  the  capital  of  the  Kingdom  of  Wurttemberg, 
for  instance,  is  an  important  center  of  the  glove  industry.  There 
were  revealed  in  the  first  year  of  the  operation  of  the  compulsory 
notification  law  of  1909  22  cases  of  anthrax^  of  which  2  were  fatal. 
This  indicated  a  greater  prevalence  of  anthrax  among  tannery 
workers  than  was  shown  by  earlier  data,  and  as  a  result  the  regula- 
tions for  the  leather  industry  were  introduced  by  ministerial  order.2 

The  French  regulations  for  tanneries  have  been  discussed  in  the 
preceding  section. 

Incidentally  it  may  be  remarked  that  in  Italy,  the  home  of  the 
Sclavo  serum  and  the  scene  of  much  intelligent  private  activity 
against  anthrax,  the  Government  remains  practically  inactive  on  the 
question.  Despite  the  appalling  prevalence  of  the  disease  no  legis- 
lation exists  for  its  prevention  among  industrial  workers.3  In  1911, 
in  accordance  with  a  decree  of  the  minister  of  agriculture,  industry, 
and  commerce  and  a  decision  of  the  administrative  council  of  the 
national  workmen's  accident  insurance  fund,  prizes  were  offered  for 
the  best  essays  on  a  number  of  topics  connected  with  industrial 
safety  and  hygiene.  One  of  the  subjects  was  prevention  of  anthrax 
among  workers  employed  in  the  transportation  and  treatment  of 
skins,  but  none  of  the  essays  submitted  were  deemed  worthy  of  the 
prize. 

1  See  Appendix,  p.  149. 

2  Bulletin  of  the  International  Labor  Office,  Vol.  VIII,  1913,  p.  XVI. 

3  L.  Devoto  and  F.  Massarelli :  II  Charbonchio  Professionale,  II  Lavoro,  July  15,  1914, 
p.  194. 

42806°— Bull.  205—17 8 


112  BULLETIN   OF    THE   BUREAU    OF   LABOR   STATISTICS. 

COMPENSATION  FOR  ANTHRAX  AS  AN  INDUSTRIAL  INJURY. 

Thorough  as  is  much  of  the  administration  of  European  factory 
law,  the  "  policing  "  method  alone  has  not  been  depended  upon  for 
the  enforcement  of  regulations  for  the  prevention  of  anthrax.  The 
method  of  cooperative  pressure  on  employers  through  workmen's 
compensation,  which  has  proved  so  effective  in  reducing  work  acci- 
dents, while  at  the  same  time  it  safeguards  the  economic  position 
of  the  injured  or  of  their  dependents,  has  already  been  applied  to  a 
number  of  occupational  diseases,  but  to  none  so  early  or  so  widely 
as  to  anthrax.  At  least  five  European  countries  (Great  Britain, 
Germany,  France,  Italy,  and  Holland),  and  two  Provinces  of  one  of 
these  (South  Australia  and  Ontario),  already  provide  compensation 
for  this  disease.1 

The  British  Workmen's  Compensation  Act  of  1897,  the  first  of  its 
kind  in  any  English-speaking  country,  established  indemnity  for 
personal  injury  "  by  accident "  arising  out  of  and  in  the  course  of 
employment.  In  1905  the  House  of  Lords  was  called  upon  to  deter- 
mine, on  an  appeal,  whether  the  dependents  of  a  workman  who  had 
died  of  anthrax  were  entitled  to  compensation  under  this  act.  The 
House  decided  in  the  affirmative,  Lord  Macnaghten  saying: 

It  is  plain,  I  think,  that  the  mischief  which  befell  the  workman  in 
the  present  case  was  due  to  accident,  or  rather,  I  should  say,  to  a 
chapter  of  accidents.  It  was  an  accident  that  the  noxious  thing  that 
settled  on  the  man's  face  happened  to  be  present  in  the  materials 
which  he  was  engaged  in  sorting.  It  was  an  accident  that  this 
noxious  thing  escaped  the  down  draft  or  suck  of  the  fan  which 
the  Board  of  Trade,  as  we  were  told,  requires  to  be  in  use  while  work 
is  going  on  in  such  a  factory  as  that  where  the  man  was  employed. 
It  was  an  accident  that  the  thing  struck  the  man  on  a  delicate  and 
tender  spot  in  the  corner  of  his  eye.  It  must  have  been  through  some 
accident  that  the  poison  found  entrance  into  the  man's  system,  for 
the  judge  finds  that  there  was  no  abrasion  about  the  eye,  while  the 
medical  evidence  seems  to  be  that  without  some  abrasion  infection  is 
hardly  possible.  The  result  was  anthrax,  and  the  end  came  very 
speedily.  Speaking  for  myself,  I  can  not  doubt  that  the  man's  death 
was  attributable  to  personal  injury  by  accident  arising  out  of  and 
in  the  course  of  his  employment.  The  accidental  character  of  the  in- 
jury is  not,  I  think,  removed  or  displaced  by  the  fact  that,  like  many 
other  accidental  injuries,  it  set  up  a  well-known  disease,  which  was 
immediately  the  cause  of  death,  and  would  no  doubt  be  certified  as 
such  in  the  usual  death  certificate.2 

1  In  addition  it  should  be  remembered  that  in  most  European  countries,  including 
Austria,  Germany,  Great  Britain,  Holland,  Hungary,  Luxemburg,  Norway,  Roumania, 
Russia,  and  Serbia,  anthrax  is  covered  by  compulsory  health-insurance  laws,  while  in 
six  countries,  Belgium,  Denmark,  France,  Iceland,  Sweden,  and  Switzerland,  a  limited 
amount  of  protection  is  given  by  systems  of  subsidized  health  insurance. 

2Brintons   (Ltd.)   v.  Turvey,  92  L.  T.  R.,  578   (1905). 


ANTHRAX   AS  AN    OCCUPATIONAL   DISEASE. 


113 


Other  cases  of  occupational  disease  also  arose  which  caused  litiga- 
tion under  the  law,  so  that  when  Parliament  enacted  the  present 
British  compensation  statute  in  1906  it  included  a  list  of  six  trade 
diseases  (since  expanded  to  25)  which  were  to  be  compensated  on 
the  same  terms  as  accidents.  One  of  these  six  was  anthrax.1  Sec- 
tion 8  of  the  law  states  that  if  the  certifying  surgeon  for  the  dis- 
trict testifies  that  a  workman  is  suffering  from  a  disease  to  which  the 
act  applies  and  is  thereby  either  unable  to  earn  full  wages  or  is  sus- 
pended from  work,  or  if  death  is  caused  by  any  such  disease  and  "  the 
disease  is  due  to  the  nature  of  any  employment  in  which  the  work- 
man was  employed  at  any  time  within  the  12  months  previous  to  the 
date  of  the  disablement  or  suspension,  whether  under  one  or  more 
employers,  he  or  his  dependents  shall  be  entitled  to  compensation 
under  this  act  as  if  the  disease  or  such  suspension  as  aforesaid  were  a 
personal  injury  by  accident  arising  out  of  and  in  the  course  of  that 
employment." 

In  the  seven  years  1908  to  1914,  the  only  years  for  which  data  are 
available,  233  cases  of  anthrax  have  been  compensated  under  the 
law.  The  following  table  shows  the  distribution  of  the  cases  by 
year  and  by  industry : 

Table  15.— CASES  OP  ANTHRAX  COMPENSATED  FOR  THE  FIRST  TIME  DURING  THE 
YEAR  UNDER  THE  BRITISH  WORKMEN'S  COMPENSATION  ACT,  1908  TO  1914. 

[Compiled  from  Home  Office  annual  reports  on  statistics  of  compensation  and  of  proceedings  under  the 
Workmen's  Compensation  Act,  1900,  and  the  Employers'  Liability  Act,  1880.] 


Year. 

Cotton . 

Wool, 
worsted, 

and 
shoddy. 

Other 
textiles. 

Engi- 
neering 
and  ship- 
building. 

Other 
metal 
work. 

China 
and 
earthen- 
ware. 

Miscella- 
neous 
factories. 

Docks. 

Total. 

1908     .   ... 

1 

4 

1 

1 

8 
7 
•5 
5 
6 
18 
13 

8 
5 
10 
4 
6 
2 
5 

23 

1909 

6 
19 

20 
26 
24 
16 

3 
1 
1 
5 

1 

22 

1910 

35 

1911....... 

30 

1912 

43 

1913 

44 

1914 

1 

1 

36 

Total 

1 

111                15                 1 

2 

1 

62 

40 

233 

It  is  interesting  to  note,  in  connection  with  the  British  experience, 
that  the  example  of  the  mother  country  has  encouraged  both  South 
Australia2  and  Ontario3  to  write  into  their  compensation  laws  the 
principle  of  indemnity  for  occupational  diseases,  each  Province 
adopting  the  schedule  of  six  compensable  diseases,  including  anthrax, 
with  which  Great  Britain  began. 

The  terms  of  the  German  workmen's  compensation  code  cover  only 
injuries  by  "  accident,"  but,  as  in  Great  Britain  under  the  law  of 

1  6  Edw.  VII,  ch.  47,  third  schedule. 

2  South   Australia,    2    Geo.    V,    No.    1053    (1911). 
8  Ontario,  4  Geo.  V,  ch.  25    (1914). 


114  BULLETIN   OF   THE  BUREAU   OF   LABOR  STATISTICS. 

1897,  anthrax  is  held  to  be  an  accident  and  is  compensated  as  such.1 
The  same  situation  obtains  in  Holland  by  a  decision  of  1905, 2  and  in 
France.3  In  the  last-named  country  the  question  of  indemnity  for 
trade  diseases  came  up  soon  after  the  enactment  of  the  compensation 
law  in  1898,  and  a  committee  on  industrial  hygiene  was  appointed 
under  the  Ministry  of  Commerce  to  study  it.  The  commission's 
report,  published  in  1903,  concluded  with  regard  to  anthrax : 

Anthrax  has  always  an  external  origin  and  is  due  to  infection  by 
a  microbe;  this  infection  takes  place  at  a  given  moment,  and  it  cer- 
tainly furnishes  the  element  of  suddenness  required  by  the  law  of  all 
accidents  which  come  under  the  act  of  1898.4 

Since  the  publication  of  this  report  the  French  courts  have  reversed 
their  previous  opinion.,  and  in  the  years  1903  to  1909  they  decided 
four  contested  cases  which  came  before  them  in  favor  of  the  injured 
workers. 

The  movement  abroad  in  favor  of  compensation  for  occupational 
anthrax,  as  well  as  for  other  trade  diseases,  is  not  confined  to  these 
seven  countries  and  parts  of  countries.  Section  68  of  the  Swiss 
industrial  accident  insurance  law  of  1912  empowers  the  Federal 
Council  to  "  prepare  a  list  of  substances,  the  production  or  employ- 
ment of  which  occasions  dangerous  diseases.  Every  disease  exclu- 
sively or  essentially  due  to  the  action  of  one  of  those  substances  in 
an  enterprise  subject  to  insurance  is  deemed  an  accident  within  the 
meaning  of  the  present  law."  It  can  hardly  be  doubted  that  anthrax 
would  find  a  place  on  a  list  of  this  kind,  but  apparently  the  Federal 
Council  has  not  yet  exercised  its  power. 

1  Pickenbach,  Beitrag  zur  Milabranderkrankung  in  der  Lederbranche,  Aertztlicher  Sach- 
verstandigen  Zeitung,  1914,  No.  18,  p.  365. 

2  H.  A.  Van  Ysselsteyn,  General  Director  of  Labor :  Anthrax,  1912,  p.  1. 

3  J.  Cavaille :  Le-  Charbon  Professionnel,  Paris,  1911,  p.  344. 

*  France,  Commission  d'Hygiene  Industrielle,  Maladies  professionnelles,  Paris,  1903, 
p.  140. 


CHAPTER  VI. 

PRESENT  STATUS  OF  THE  PROBLEM  OF  DISINFECTION. 

It  is  obvious  that  the  success  of  the  extensive  and  energetic  cam- 
paign against  occupational  anthrax  depends  to  a  considerable  degree 
on  the  effectiveness  of  methods  of  sterilizing  industrial  materials. 
The  significance  attached  to  the  question  of  disinfection  has  stimu- 
lated numerous  investigations  in  the  more  advanced  countries.  The 
work  is  chiefly  done  in  private  laboratories,  but  important  experi- 
ments have  also  been  made  under  the  auspices  of  the  United  States 
Bureau  of  Animal  Industry  and  of  the  Imperial  Health  Office  in 
Germany,  while  facilities  for  such  work  are  furnished  by  the  Home 
Office  in  England. 

The  task  of  finding  an  adequate  and  practicable  disinfectant  is 
greatly  complicated  by  several  factors.  For  instance,  various  kinds 
of  materials  require  different  modes  of  treatment.  The  cost  of  the 
disinfectant  and  the  time  of  exposure  necessary  for  destroying  the 
bacilli  and  spores  are  also  essential  considerations,  since  an  expensive 
disinfectant,  or  one  acting  only  slowly,  will  be  rejected  by  the  manu- 
facturers. Still  more  important  is  the  effect  of  the  disinfectant  on 
the  material,  since  it  has  been  shown  that  a  large  number  of  disin- 
fectants otherwise  desirable  can  not  be  applied  without  injury  to 
the  goods. 

Of  the  materials  liable  to  convey  anthrax  to  the  workers,  bristles, 
horsehair,  goat  hair,  and  a  few  other  kinds  of  hair  have  proved  most 
susceptible  to  disinfection.  A  number  of  methods  have  been  pro- 
posed, three  of  which  are  considered  the  most  effective  and  the  most 
acceptable  for  industrial  purposes.  These  are:  (1)  Exposure  to  steam 
for  a  period  varying  according  to  temperature  and  atmospheric 
pressure;  (2)  boiling  in  water  for  two  hours;  and  (3)  boiling  for  at 
least  15  minutes  in  a  2  per  cent  solution  of  permanganate  of  potas- 
sium with  a  subsequent  bleaching  in  3  to  4  per  cent  sulphuric  acid. 

In  the  disinfection  of  wool  much  less  has  been  accomplished.  Up 
to  the  present  no  disinfectant  has  been  found  entirely  satisfactory 
for  industrial  purposes.  In  England  constant  and  diligent  study  of 
various  germicides  is  being  made  by  the  Bradford  Anthrax  Investi- 
gation Board,  which,  after  nine  j^ears  of  work,  reports  :x  "  So  far 

1  Anthrax  Investigation  Board  for  Bradford  and  District,  Ninth  Annual  Report,  1014, 
p.  6. 

115 


116  BULLETIN   OF   THE  BUREAU   OP   LABOR   STATISTICS. 

formaldehyde,  in  the  proportion  of  1  per  cent  of  neat  or  proof 
strength  to  99  per  cent  of  water,  with  a  saturation  of  the  opened 
material  for  seven  hours,  is  the  only  germicide  that  has  been  found 
reliable,  and  even  the  effect  of  this  germicide  must  depend  upon  the 
absence  of  ammonia  and  of  large  blood  clots.  The  effect  of  formalde- 
hyde upon  the  spinning  qualities  of  the  material  is,  however,  very 
marked,  and  this  germicide  can  only  be  recommended  for  extreme 
cases  of  infected  wool  or  hair."  Further  experiments  are .  being 
made. 

Steam  disinfection  of  wool  was  also  the  subject  of  a  series  of 
experiments  by  the  staff  of  the  board.  The  results  have  brought  out 
the  fact  that  while  steam  succeeds  in  destroying  the  germs  its  effect  is 
to  discolor  light-colored  material  and  to  turn  yellow  white.  The  wool 
becomes  brittle,  its  elasticity  and  luster  are  considerably  affected, 
and  the  strength  of  the  fiber  is  also  somewhat  impaired.  As  a  result 
a  committee  of  the  board  agreed  that  "  disinfection  by  steam  can  not 
be  applied  to  ordinary  wool  or  hair  except  under  conditions  that 
would  stop  any  trade  in  the  sorts  so  treated." 1 

However,  even  the  officially  approved  methods  of  disinfection  are 
not  considered  absolutely  effective,  and  occasionally  fail  to  prevent 
the  occurrence  of  anthrax.  C.  H.  W.  Page,  an  English  authority, 
expresses  himself  with  considerable  pessimism.  "  That  steam  is 
ever  likely  to  be  certainly  effective  in  disinfecting  horsehair  is  im- 
probable," he  says,  "since  the  damper  the  steam  the  better  chance 
of  destroying  the  spores,  but  the  greater  the  damage  to  the  hair; 
and  the  drier  the  steam  the  less  chance  of  destroying  the  spores  and 
the  less  damage  to  the  hair.  These  antagonistic  results  produce  a 
deadlock."2  He  also  criticizes  the  use  of  steam  on  bristles  because 
steam  bursts  or  loosens  the  bundles,  which  necessitates  an  expendi- 
ture of  time  and  money  for  putting  them  in  order  again;  nor  does 
he  find  boiling  satisfactory,  for  in  the  time  necessary  to  destroy  the 
spores — two  to  three  hours — the  material  would  be  considerably 
damaged.  His  stand  on  the  question  of  disinfection  in  general  he 
summarizes  in  the  words :  "  Great  care  and  constant  supervision  are 
necessary  to  secure  satisfactory  results,  and  steam  can  not  be  regarded 
as  absolutely  certain  in  effect,  though  the  great  bulk  of  spores  are 
destroyed  and  the  vitality  of  the  rest  is  diminished." 

Very  similar  is  the  opinion  expressed  by  another  English  authority, 
Legge,  who  states  that  to  secure  certain  destruction  of  all  anthrax 
spores  absolute  reliance  can  not  be  placed  on  either  steam  disinfection 
or  simple  boiling  in  the  absence  of  effective  supervision;  however, 
the  adoption  of  one  or  the  other  is  a  material  safeguard. 

1  Anthrax  Investigation  Board  for  Bradford  and  District,  Eighth  Annual  Report,  1913, 
p.  23. 

2  Journal   of  Hygiene,  Industrial  Anthrax,   1909,   p.  3691 


ANTHRAX   AS   AN"    OCCUPATIONAL   DISEASE.  117 

This  unreliability  of  disinfection  has  attracted  official  attention  in 
the  Grand  Duchy  of  Baden,  where,  notwithstanding  the  practice  of 
sterilization,  the  number  of  cases  of  anthrax  has  increased  rather  than 
diminished.  Prompted  by  this  circumstance  the  minister  of  the  in- 
terior, by  an  order  which  went  into  effect  October  28, 1909,  instructed 
the  proper  authorities  to  make  annual  examinations  of  fresh  disin- 
fected samples  of  materials  used  in  manufacture. x  The  examinations 
have  shown  that  disinfection  does  not  kill  the  spores.  Some  cases 
of  failure  the  author  attributes  either  to  the  wrong  construction  of 
the  apparatus  or  to  the  wrong  use  of  it.  The  individual  characteris- 
tics of  certain  kinds  of  hair  also  sometimes  impede  disinfection.  In 
this  connection  the  author  mentions  goat  hair,  which  comes  in  hy- 
draulically  pressed  bales.  Upon  unpacking,  the  whole  bale,  which 
owing  to  the  nature  of  the  hair  shows  hardly  any  tendency  to  fall 
apart,  is  exposed  to  steam ;  naturally  the  steam  can  not  penetrate  very 
deeply,  and  after  an  exposure  of  one-half  hour  the  temperature  8 
inches  below  the  surface  is  only  114.8°  F.,  which  is  insufficient  for 
sterilization. 

Still  greater  obstacles  are  in  the  way  of  disinfection  of  hides  and 
skins.  Numerous  experiments  with  these  materials  have  so  far  failed 
to  discover  a  reliable  and  convenient  germicide.  Sterilization  by 
steam,  frequently  applied  in  the  hair  industry,  is  impracticable  for 
hides  and  skins,  as  it  injures  them  for  manufacture.  Experiments 
have  been  conducted  with  low-temperature  steam  disinfection  in  a 
vacuum,  which  does  not  affect  the  skins,  but  the  question  of  the  ap- 
plicability of  this  method  for  manufacturing  purposes  has  not  so  far 
been  settled. 

Researches,  remarkable  for  their  range  and  thoroughness,  have 
been  made  under  the  auspices  of  the  Imperial  Health  Office  of  Ger- 
many. Hailer,  one  of  the  investigators,  states 2  that  disinfection  of 
skins  is  not  an  impossibility.  Numerous  methods  have  been  sug- 
gested, but  so  far  they  have  not  been  applied  outside  the  laboratory. 
The  high  cost  of  the  disinfectants,  their  poisonous  properties,  and 
their  more  or  less  deleterious  effects  on  the  skins,  serve  as  ob- 
stacles to  their  introduction  into  industry.  Of  the  several  layers  of 
which  the  animal  skin  is  composed  the  one  used  for  leather  is,  ac- 
cording to  Hailer,  sensitive  to  a  temperature  of  over  104°  F.,  and 
also  to  whole  classes  of  chemical  substances,  such  as  the  phenols, 
aldehyde  acids,  and  heavy  metal  salts — in  fact,  to  the  strongest 
germicides.    However,  some  of  the  substances  contained  in  the  skin, 

1  Laubenheimer,  fiber  die  Disinfection  von  Tierhaaren  zur  Zerhtttung  von  gewerblicher 
Milzbrand,  Zeitschrifr  fur  Hygiene  und  Infections-Krankheiten,  1912,  Vol.  LXX,  pp. 
324,  325. 

-  E.  Hailer,  Die  Abtotung  von  Milzbrandsporen  an  Hauten  und  Fellen  durch  Salzsaure- 
Kochsalzlosungen.  Arbeiten  aus  dem  Kaiserlichen  Gesundheitsamte.  Berlin,  1914, 
Vol.  XLVII,  p.   69. 


118  BULLETIN"   OF    THE   BUREAU    OF   LABOE   STATISTICS. 

chiefly  the  albuminoids,  make  insoluble  compounds  with  these  chemi- 
cals, and  as  a  result  the  skins  change  in  appearance  and  become  less 
valuable  for  manufacture.  Numerous  efforts  for  the  removal  of 
these  difficulties  have  met  with  little  success. 

At  present  there  are  two  methods  of  disinfection  which  give  prom- 
ise of  meeting  the  necessary  requirements;  neither  has  yet  been 
applied  on  a  large  scale,  but  one,  recommended  by  Seymour-Jones 
of  England,  chairman  of  the  International  Commission  for  the 
Preservation,  Cure,  and  Disinfection  of  Hides  and  Skins,  seems  to 
be  meeting  with  more  approval  than  the  other.  This  process  con- 
sists in  soaking  the  dry  skins  for  24  hours  in  a  1  to  5,000  solution 
of  bichloride  of  mercury  to  which  is  added  a  1  per  cent  solution  of 
formic  acid.  After  this  treatment  the  skins  are  transferred  for  an 
hour  or  so  to  a  saturated  solution  of  common  salt  in  water.  The  acid 
helps  to  render  the  bichloride  effective  because  it  prevents  the  forma- 
tion of  the  insoluble  albuminate  of  mercury,  and  also  because  by  its 
penetrating  action  the  fluid  is  carried  into  the  center  of  the  mass  of 
any  organic  material  that  may  serve  as  a  protection  for  the  spores. 

The  process  has  been  the  subject  of  an  exhaustive  investigation  by 
Constant  Ponder,  who  considers  it  simple,  cheap,  and  effective,  and 
"  believes  that  it  holds  out  greater  promise  of  success  than  any  pro- 
cess hitherto  suggested." x  He  suggests  that  the  sterilization  be  car- 
ried out  in  the  port  of  shipment. 

The  other  process  was  discovered  by  a  German  scientist,  Schat- 
tenfroh.  This  investigator  recommends  that  hides  and  skins  be 
soaked  for  six  hours  at  a  temperature  of  104°  F.,  or  for  two  days  at  a 
temperature  of  68°  F.,  in  a  2  per  cent  solution  of  hydrochloric  acid  to 
which  a  10  per  cent  solution  of  ordinary  salt  is  added.  For  practical 
reasons  he  considers  the  former  method  superior.  He  maintains  that 
no  injury  is  done  to  the  skins  by  this  process? 

In  the  United  States  numerous  studies  of  disinfection  against 
anthrax  have  been  made  by  the  Federal  Bureau  of  Animal  Industry, 
as  well  as  by  the  National  Association  of  Tanners  and  by  the  Ameri- 
can Leather  Chemists'  Association,  at  whose  meetings  the  problem 
is  the  subject  of  frequent  reports  and  discussions.  In  1910  John  H. 
Yocum,  of  the  leather  chemists'  organization,  pointed  out  that  be- 
cause of  the  action  of  the  mercury  salt  in  forming  insoluble  com- 
pounds with  albuminoids  and  thereby  depriving  itself  of  further 
power  to  act  on  bacteria,  immersion  in  a  simple  1  to  1,000  solution 
of  bichloride  of  mercury  as  then  required  by  the  Government  could 
"not  possibly  be  effective."    He  proposed  modifying  the  process  by 

1  Constant  Ponder :  A  Report  to  the  Worshipful  Company  of  Leather  Sellers,  etc.,  1911, 
p.  VI. 

2  E.  Hailer  :  Die  Abtotung  von  Milzbrandsporen  an  Hauten  und  Fellen  durch  Salzsaure- 
Kochsalzlbsungen.  Arbeiten  aus  dem  Kaiserlichen  Gesundheitsamte.  Berlin,  1914,  Vol. 
XLVII,  p.  69. 


ANTHRAX   AS  AN"    OCCUPATIONAL  DISEASE.  119 

adding  the  bichloride  to  a  saturated  solution  of  common  salt,  which 
would  prevent  interference  with  the  germicide.  This  method,  how- 
ever, he  found  efficacious  only  for  wet  salted  hides.  For  dry  hides  he 
declared  it  impracticable  because  of  the  long  time  the  fluid  required 
for  penetration,  and  recommended  instead  the  Seymour-Jones  proc- 
ess, 1  to  5,000  bichloride  of  mercury  with  1  per  cent  formic  acid. 
This  latter  process,  Yocum  estimated,  would  entail  an  expense  of 
about  7  cents  a  hide,  which  he  held  would  be  more  than  equalized 
by  economies  in  the  selection  and  tanning  of  hides  which  it  would 
make  possible.  If  the  process  were  carried  on  at  the  point  of  ship- 
ment, it  was  further  pointed  out,  shippers  would  not  be  likely  to 
dry  the  hides  out  again,  so  that  many  of  the  hides  now  received  in 
the  "  flint  dry  "  state  would  be  received  as  "  wet  salts,"  with  a  con- 
sequent reduction  of  the  danger  of  anthrax  infection  through  flying 
dust.  The  paper  was  circulated  for  discussion  at  the  following 
meeting  of  the  tanners,1  who  seemed  to  feel,  however,  that  it  should 
be  subjected  to  important  modification. 

Perhaps  the  most  extensive  series  of  American  experiments  on  the 
subject  are  those  undertaken  by  F.  W.  Tilley,  of  the  United  States 
Bureau  of  Animal  Industry. 2  These  experiments  tend  to  show  that 
the  original  Seymour-Jones  process,  immersion  in  1  to  5,000  mercuric 
chloride  solution  with  1  per  cent  formic  acid  for  24  hours,  is  not 
efficient  in  killing  anthrax  spores,  even  if  the  germicide  is  not  later 
neutralized  as  it  would  be  by  other  substances  in  the  regular  course 
of  tanning.  A  modification  of  the  Seymour-Jones  method,  however, 
by  using  a  mercuric  chloride  solution  of  twice  this  strength  (1  to 
2,500),  with  1  per  cent  of  formic  acid,  is  efficient  in  24  hours  if  there 
is  no  neutralization.  Hence  this  latter  method,  the  investigator  con- 
cluded, seems  usable  "  provided  the  treated  hides  are  not  to  be  sub- 
jected within  a  week  or  two  to  the  action  of  any  substances  which 
will  neutralize  the  disinfectant.  This  would  be  the  case,  for  in- 
stance, if  the  hides  were  disinfected  at  foreign  ports  before  ship- 
ment to  this  country." 

Similar  researches  carried  on  with  the  Schattenf roh  method,  2  per 
cent  of  hydrochloric  acid  in  a  10  per  cent  solution  of  sodium  chloride, 
with  48  hours'  exposure,  are  reported  to  have  "  proved  efficient  in 
every  instance."  A  European  bacteriologist, 3  however,  is  quoted  as 
having  found  that  this  method  works  well  for  thin  skins,  but  that 
if  the  skins  were  "  thick  and  heavily  infected  he  was  able,  after 

1  John  H.  Yocum  :  Disinfection  of  imported  hides.  National  Association  of  Tanners, 
1913. 

2  F.  W.  Tilley:  A  bacteriological  study  of  methods  for  the  disinfection  of  hides  infected 
with  anthrax  spores.  Journal  of  Agricultural  Research,  Mar.  15,  1915,  pp.  65-92  ; 
abridged  in  Journal  of  the  American  Leather  Chemists'  Association,  March,  1910. 

3  Franz  Sevcik  :  Zur  Desinfection  von  Milzbrandhauten.  In  Weiner  Aertaliche  Monat- 
schrift,  Vol.  I,  No.  3,  pp.  127-141. 


120  BULLETIN   OF    THE   BUREAU    OF    LABOR   STATISTICS. 

very  effective  neutralization,  to  extract  from  pieces  of  the  treated 
hides  anthrax  spores  which  were  virulent." 

In  all  his  work  Tilley  has  emphasized  what  he  considers  the  ex- 
tremely slow  and  superficial  action  of  bichloride  of  mercury.  "  Cer- 
tainly for  a  short  time,"  he  says,  "  the  combination  between  the  bi- 
chloride and  the  spores  is  what  we  might  call  a  '  reversible '  combina- 
tion," and  the  effect  of  a  neutralizing  agent,  such  as  the  lime  used 
in  later  processes,  "  will  be  to  break  the  combination,  and  the  spores 
will,  so  to  speak,  come  to  life  again."1  For  this  reason  he  recom- 
mends a  long  immersion  in  a  relatively  weak  solution  as  preferable 
to  a  brief  immersion  in  a  stronger  solution.  On  the  whole  he  con- 
siders the  Schattenf roh  method,  though  not  perfect,  "  far  superior  to 
other  methods  and  well  worth  a  trial  as  a  standard  method  for  the 
disinfection  of  hides." 

On  the  other  hand,  a  committee  report  submitted  to  the  annual 
meeting  of  the  American  Leather  Chemists'  Association  in  June, 
1916,  stated  that  tanners  who  had  tried  the  Schattenf  roh  method  de- 
clared it  "positively  injurious"  to  hides,  while  at  the  same  time  bi- 
chloride of  mercury  solution  of  the  strength  (1  to  1,000)  then  re- 
quired by  the  Government  was  complained  of  as  "burdensome  in 
point  of  cost." 2  The  committee  therefore  tentatively  proposed  a  new 
method  to  supersede  both  of  these.  Stating  that  no  cases  of  anthrax 
had  occurred  in  glue  or  hair  factories  using  by-products  from  Ameri- 
can tanneries,  the  committee  suggested  that  bichloride  of  mercury 
1  to  5,000  or  possibly  1  to  10,000,  followed  by  the  regular  liming 
process,  "  will  prove  effective  in  rendering  the  anthrax  spores  in- 
nocuous. If,  after  further  investigation,  this  proves  to  be  a  fact  it 
will  meet  the  situation  and  relieve  the  tanners  from  undue  burden  or 
cost."  This  suggestion  had  already  been  conveyed  to  the  Bureau  of 
Animal  Industry,  and  as  has  been  seen  a  slight  modification  of  the 
proposed  process  is  embodied  in  the  rules  prepared  by  the  Federal 
authorities,  in  cooperation  with  the  tanners'  committee,  later  in  the 
year.3 

The  other  products  liable  to  convey  anthrax,  chiefly  bones  and 
horns,  are  used  to  a  more  limited  extent  than  hair,  wool,  or  hides, 
and  danger  of  infection  from  them  is  also  comparatively  slight.  For 
these  reasons  their  sterilization  is  less  urgent,  and  it  has  been  almost 
disregarded  in  the  spirited  campaign  for  protection  against  the  more 
common  carriers  of  the  disease. 

1  Journal  of  the  American  Leather  Chemists'  Association,  July,  1916,  p.  350. 

2  C.  R.  Oberfell :  Cure  and  Disinfection  of  Hides.  Committee  report,  1916.  Journal  of 
the  American  Leather  Chemists'  Association,  July,  1916,  pp.  333-339. 

3  See  Appendix  A. 


CHAPTER  VII. 

RECOMMENDATIONS  FOR  CONTROL  AND  PREVENTION 

OF  ANTHRAX. 

The  serious  difficulties  in  the  way  of  a  satisfactory  solution  of  the 
occupational  anthrax  problem  have  been  the  subject  of  considerable 
expert  study.  Since  it  has  not  yet  proved  possible  to  eradicate 
anthrax  even  in  the  countries  where  the  most  advanced  legislation 
on  the  subject  is  combined  with  enlightened  private  activity,  addi- 
tional measures  of  protection  are  necessary. 

After  careful  study  of  the  problem  several  authorities  of  world- 
wide reputation  have  set  forth  recommendations  in  which  they  take 
up  not  only  the  question  of  anthrax  in  manufacturing  centers,  but 
also  in  the  stock-raising  countries  of  export,  and  in  which  the  neces- 
sity of  international  action  is  emphasized. 

Of  the  recommendations  published  in  recent  years  three  sets  are 
conspicuous  for  their  thoroughness  and  for  the  extensiveness  of  the 
ground  covered,  and  are  here  given  entire. 

RECOMMENDATIONS    OF    SUBCOMMITTEE    OF    INTERNATIONAL 
ASSOCIATION  FOR  LABOR  LEGISLATION,  1914.1 

A.  It  is  important  (in  order  to  be  in  a  position  to  know  the  extent  of  the 
risk  of  anthrax  infection  in  industries  and  the  preventive  measures  necessary 
to  combat  it)  that  in  each  country  full  statistics  should  be  kept  of  cases  which 
arise. 

Such  statistics  should  always  supply  the  following  information :  Age  and  sex 
of  the  patient ;  precise  occupation ;  the  kind  and  source  of  the  materials 
handled  at  the  time  of  the  attack ;  situation  and  clinical  form  of  the  disease ; 
result. 

It  is  desirable  that  these  statistics  should  be  as  wide  as  possible  and  cover 
all  cases  of  anthrax — agricultural  as  well  as  industrial. 

B.  In  all  premises  where  the  products  (wool,  hair,  bristles,  hides,  and  skins) 
of  animals  susceptible  of  anthrax  are  stored  and  handled  in  the  raw  state 
the  occupier  should  post  up  a  notice  containing — 

(«)  An  illustration  showing  the  commonest  and  most  characteristic  form 
of  external  anthrax    (malignant  pustule)  ; 

( b )  A  brief  account  of  its  origin  and  the  typical  forms  of  infection ; 

(c)  A  warning  to  the  persons  employed  as  to  the  importance  of  personal 
cleanliness  and  the  necessity  of  prompt  treatment  for  every  lesion,  however 
slight. 


1  Appointed  to  consider  the  question  of  anthrax,  in  accordance  with  the  decision  of  the 
seventh  delegates'  meeting  of  the  association,   1912. 

121 


122  BULLETIN    OF    THE   BUREAU    OF    LABOR   STATISTICS. 

C.  In  all  premises  where  wool,  hair,  bristles,  hides,  and  skins  coming  from 
suspected  countries  are  stored  and  handled  in  the  raw  state,  the  occupier  should 
adopt  the  following  measures.  (It  will  fall  to  the  Government  of  each  coun- 
try to  decide  on  and  classify  in  one  or  more  schedules,  according  to  the  degree 
of  risk  and  quantity  of  material  imported,  the  countries  to  be  declared  "  sus- 
pected.") 

1.  Inspectors  of  factories  should  be  permitted  by  the  occupier  to  inspect 
either  the  stock  book  in  which  is  entered  the  purchase  of  material  for  the 
factory  or  workshop  or  a  special  register  with  entries  as  follows :  Nature  and 
quantity  of  material  introduced ;  date  of  receipt ;  country  of  origin ;  state 
( whether  raw  or  disinfected )  of  the  products  ;  name  of  the  vendor.  And  in  the 
case  of  material  said  to  have  been  disinfected  before  introduction  into  the  fac- 
tory, an  approved  certificate  to  that  effect. 

2.  All  scheduled  raw  materials  which  can  be  subjected  to  the  operation  with- 
out damage  should  be  disinfected. 

3.  Opening  of  bales  of  wool,  hair,  bristles,  hides,  and  skins  should  always 
be  intrusted  to  persons  skilled  in  judging  the  portions  which  are  damaged. 

4.  Preliminary  operations  regarded  as  particularly  dangerous  should  always 
be  carried  out  in  a  room,  or  portion  of  a  room,  set  apart  for  the  purpose. 

(It  will  fall  to  the  Government  of  each  country,  having  regard  to  the  different 
processes  of  manufacture  and  manipulation  customary  in  each  country  and  in 
each  industry  under  regulation,  to  define  what  are  the  preliminary  operations 
to  be  regarded  as  dangerous.) 

5.  Wool  and  hair  sorting  should  always  be  carried  on  so  as  to  permit  of  the 
removal  of  blood  clots  adhering  to  the  fleece,  and  of  bloodstained  portions. 
These  fragments  should  either  be  burned  or  sterilized  by  a  process  recognized 
as  efficient. 

6.  The  preliminary  manipulations  as  defined  above,  which  are  carried  out  on 
dusty  material  treated  in  a  dry  state,  should  be  carried  on  under  an  efficient 
exhaust  draft  preferably  in  a  downward  direction.  The  dust  should  never 
be  allowed  to  escape  into  the  open  air. 

The  dust  collected  in  a  special  receptacle  should  either  be  burned  (unless 
coming  from  material  that  has  previously  been  washed)  or  rendered  harmless 
by  treatment,  chemical  or  otherwise. 

7.  The  workrooms  in  which  the  preliminary  processes  are  carried  on  should 
be  kept  in  a  constant  state  of  cleanliness;  the  floors  should  be  impermeable, 
and  the  walls  treated  in  such  a  way  as  to  permit  of  thorough  washing,  or 
limewashed  at  least  once  a  year. 

The  floor,  walls,  tables,  benches,  tools,  and  machines  should  be  frequently 
cleaned. 

8.  The  occupier  should  provide  for  the  persons  employed  in  the  preliminary 
manipulations  means  for  securing  personal  cleanliness;  a  cloakroom  (with 
arrangements  for  keeping  separate  the  ordinary  clothes  from  clothing  worn 
while  at  work)  and  a  lavatory  with  an  abundant  supply  of  water  (hot  and 
cold  whenever  possible),  soap,  nailbrushes,  and  towels. 

Every  person  employed  in  handling  raw  material  should  be  provided  with  his 
own  overalls  and  head  covering. 

Persons  employed  in  cleaning  dust-extracting  machines  and  receptacles  for 
dust  should  be  provided  with  respirators. 

No  food  or  drink  should  be  deposited  or  partaken  of  in  rooms  where  danger- 
ous processes  are  carried  on. 


ANTHRAX  AS  AN    OCCUPATIONAL  DISEASE.  123 

9.  Medical  treatment  should  be  organized  on  the  following  lines : 

Every  person  employed  having  a  pustule  or  pimple  resembling  anthrax 
should  report  the  fact  without  delay  at  the  manager's  office,  whereupon  the 
occupier,  on  his  part,  should  cause  him  to  be  examined  by  a  surgeon  appointed 
for  the  purpose. 

The  name  and  address  of  the  surgeon  should  be  entered  on  the  notice  provided 
under  B,  above. 

10.  Every  factory  and  workshop  should  be  provided  with  an  ambulance  box 
kept  in  good  condition  and  in  a  place  easily  accessible. 

11.  No  person  under  18  years  of  age  should  be  employed  in  the  preliminary 
operations  defined  above. 

D.  It  is  desirable  that  in  all  countries  where  stock  is  raised,  sanitary  regula- 
tions drawn  up  on  the  same  lines  should  be  seriously  applied  with  a  view  to 
bring  about  diminution  in  the  epizootic  spread  of  anthrax,  and  destruction  by 
efficiently  organized  methods  of  all  the  products  or  offal  of  animals  that  have 
died  of  anthrax. 
The  members  of  the  subcommittee : 

Db.  Koelsch,  Chief  Medical  Inspector,  Munich. 
Db.  Legge,  Medical  Inspector,  London. 
J.  Cavaille,  Inspector  of  Labor,  Castres. 

RECOMMENDATIONS  BY  PROF.   L.  DEVOTO   AND  F.  MASSARELLI.1 

1.  Compulsory  antianthrax  vaccination  of  animals.  The  committee  can  not 
ignore  the  fact  that  such  a  measure  is  very  difficult  if  not  impossible  of  execu- 
tion in  foreign  countries  where  anthrax  is  endemic,  and  if  limited  to  our  own 
country  it  can  not  have  the  slightest  influence  in  the  prevention  of  occupational 
anthrax. 

2.  Concentration  of  the  cargoes  of  animal  material  coming  from  foreign 
sources  in  specially  designated  ports  having  special  and  exclusive  storehouses 
for  said  material,  fitted  up  with  smooth  walls  and  floors  to  facilitate  periodical 
disinfection. 

3.  Adoption  of  sanitary  regulations  for  the  transportation  of  said  material 
at  the  points  of  disembarkation — regulations  which  might  be  formulated  as 
follows : 

(a)  Isolate  from  other  merchandise  the  hides,  etc.,  of  suspected  animals  on 
board  sailing  vessels  and  steamboats,  and  after  the  discharge  of  every  invoice 
disinfect  the  place-  of  storage  while  in  transit. 

(&)  Use  for  discharging  cargoes  of  animal  material  special  lighters  which, 
until  disinfected,  are  not  to  serve  for  other  transportation. 

(c)  Forbid  the  transportation  of  suspected  material  on  the  bare  shoulder, 
and  furnish  laborers  with  impermeable  clothing  and  head  covering,  this  last  to 
protect  securely  the  throat,  back  of  the  head,  and  face  by  means  of  a  cape; 
also  supply  all  facilities  for  washing  after  work,  soap,  etc.,  if  not  disinfecting 
solutions. 

Analogous  regulations  should  be  adopted  in  railway  transportation. 

4.  Request  the  Governments  to  make  compulsory  sanitary  regulations  (after 
the  manner  of  those  established  in  Germany,  France,  etc.)  obligatory  on  the 
part  of  manufacturers  and  on  the  part  of  workmen  in  establishments  where 
animal  substances  are  handled. 


1  From  an  article  on  II  Charbonchio  Professionale,  II  Lavoro,  July  15,  1914.  p.  197. 


124  BULLETIN    OF    THE   BUREAU    OF   LABOB   STATISTICS. 

5.  Preventive  vaccination  of  the  workmen  who  come  into  immediate  contact 
with  the  imported  material. 

6.  Diffuse  among  the  workmen  by  means  of  pictures,  publications,  and 
models  a  knowledge  of  methods  for  the  early  recognition  of  the  pustules,  and 
institute  a  propaganda  in  favor  of  using  antianthrax  serum  as  a  prophylactic 
and  curative  agent. 

RECOMMENDATIONS  BY  C.  H.  W.  PAGE.1 

The  fact  that  practically  all  bristles  and  horsehair  on  arrival  in  this  country 
are  centered  for  a  time  in  two  or  three  London  warehouses  raises  the  ques- 
tion whether  it  would  not  be  possible  to  disinfect  the  material  before  distribu- 
tion. Were  disinfection  thus  centralized  it  would  be  a  comparatively  simple 
matter  to  protect  the  limited  number  of  people  exposed  to  risk  in  cutting  the 
knots  of  the  bundles  and  spreading  the  horsehair  out  for  disinfection;  then 
the  necessity  for  formal  regulations  in  horsehair  and  brush-making  factories 
and  workshops  in  a  great  measure  would  be  obviated.  The  manufacturers 
would  gain  in  being  freed  from  risk  of  anthrax  among  their  employees  and, 
further,  would  be  able  to  use  hair  that  many  of  them  have  preferred  to  discard 
on  account  of  its  dangerous  properties. 

With  regard  to  the  measures  introduced  in  Germany  a  few  years  ago, 
and  quite  recently  in  England,  more  stress  might  be  laid  on  the  necessity  of 
washing,  use  of  nailbrush,  keeping  the  nails  short;  in  washing,  the  use  of  an 
efficient  disinfectant  is  advisable ;  for  this  purpose  Gyllin  does  admirably,  being 
compatible  with  soap.  Experience  shows  that  soap  and  water  are  the  true 
safeguards  after  handling  infected  material,  and  those  who  use  the  same  stuff 
after  disinfection  should  wash  hands,  face,  and  neck  before  going  home  to  a 
meal.  By  these  means,  too,  the  likelihood  of  workers  carrying  infection  outside 
would  be  diminished.  The  ignorance  and  carelessness  of  the  workers  are 
undoubted  factors  in  the  spread  of  anthrax.  The  use  of  overalls  and  gloves, 
though  unpleasant  and  disliked  by  the  workpeople,  yet  is  very  necessary,  as 
cases  quoted  show. 

Facilities  for  bacteriological  examination  given  by  the  Home  Office  since  1899 
for  verification  of  doubtful  cases  might  with  advantage  be  extended  to  exami- 
nation of  suspected  samples  of  hair,  etc. 

It  would  be  advisable  to  require  the  registrar  to  communicate  with  the  coroner 
in  all  fatal  cases  of  anthrax. 

When  possible,  walls  and  pavements  of  factories  and  workshops  should  be 
painted  or  glazed  so  as  to  be  easy  to  clean  and  disinfect. 

Early  diagnosis  of  anthrax  being  difficult,  it  is  essential  for  a  medical  man 
to  be  attached  to  each  factory,  or  group  of  factories,  to  whom  all  cases  may  be 
referred,  so  that  in  making  a  diagnosis  the  nature  of  the  employment  may  be 
taken  into  consideration.  By  this  timely  vigilance,  remedies,  harmless  in  any 
case,  may  be  used  with  far  greater  prospect  of  success. 

The  duties  of  certifying  factory  surgeons  might  be  extended  with  advantage 
to  include  the  above  work,  and  that  there  might  be  no  delay  they  should  be 
supplied  with  serum  by  the  Home  Office.  The  surgeons  should  collect  samples 
of  suspected  material  for  bacteriological  examination,  should  undertake  the 
entire  treatment  of  all  cases  of  anthrax,  and,  in  conjunction  with  the  local 
factory  inspector,  conduct  an  inquiry  into  the  source  of  infection. 

1  From  summary  of  article  on  British  Industrial  Anthrax,  Journal  of  Hygiene,  Decem- 
ber, 1909,  pp.  390-395. 


ANTHRAX  AS  AIT   OCCUPATIONAL  DISEASE.  125 

Employees  absent  from  work  should  report  to  the  employer  the  cause,  and 
In  the  case  of  illness  of  any  kind  the  employee  should  be  visited  at  once  by 
the  certifying  factory  surgeon. 

The  employer  should  exclude  as  far  as  possible  workpeople  with  cuts  or 
abrasions  unless  suitably  covered,  and  for  the  carrying  out  of  all  regulations 
each  factory  and  workshop  should  be  supplied  with,  or  compelled  to  supply, 
means  for  dressing  small  cuts,  etc. 

All  cases  of  human  anthrax,  whether  industrial  or  agricultural,  should  be 
notified.  Both  human  and  animal  cases  of  anthrax  should  be  notified  to  one 
authority,  or  to  both  the  board  of  agriculture  and  the  Home  Office,  so  that  if 
thought  advisable  the  inquiry  may  be  made  in  common. 

Human  anthrax  being  so  closely  associated  with  animal  anthrax,  more  sys- 
tematic efforts  should  be  made  (1)  by  limiting  the  spread  of  the  disease  in 
nature,  and  (2)  by  the  immunization  of  animals  against  anthrax  to  exterminate 
the  disease  among  animals. 

It  is  necessary  to  dispose  of  the  carcasses  without  shedding  of  blood,  so  that 
no  part  may  be  used,  either  (1)  by  burning,  or  (2)  by  deep  burial,  preferably 
in  quicklime.  These  methods  are  equally  effective,  but  perhaps  for  smaller 
carcasses  burning  is  to  be  recommended  and  for  larger  ones  deep  burial.  All 
places  likely  to  have  been  contaminated  with  any  discharges  should  be  thor- 
oughly disinfected,  as  with  1  in  1,000  corrosive  sublimate. 

Investigations  should  be  undertaken  in  each  country  or  by  some  international 
organization,  to  determine  accurately  the  nature  and  extent  of  anthrax  districts, 
which  should  be  then  kept  under  supervision  and,  where  possible,  drained  or 
rendered  innocuous  by  other  means.  Such  measures  would  result  in  a  consider- 
able reduction  in  anthrax  among  animals  and  consequently  among  human  beings. 
Such  an  organization  would  give  warning  of  the  prevalence  of  anthrax  in  these 
districts,  so  that  export  of  infected  material  might  be  controlled. 

Dust  from  horsehair  factories  is  not  infrequently  sold.  *  *  *  Hence  it 
is  necessary  to  prevent  the  sale  of  dust  arising  in  the  manipulations  of 
dangerous  or  nondisinfected  raw  animal  products  and  to  do  this  separate 
tables  and  rooms  should  be  used  for  such  material.  Such  dust  should  be  burned. 
The  effluent  from  wool,  hair,  and  skin  factories  should  be  rendered  inert  by 
some  reliable  process,  such  as  prolonged  boiling,  before  being  discharged,  or 
treated  by  a  suitable  strength  of  some  such  disinfectant  as  Cyllin. 

Other  general  measures,  as  notification  of  all  cases  of  deaths  of  animals 
from  any  acute  disease  and  of  those  rendering  necessary  slaughter  on  the  farm 
are  desirable.  A  fee  should  be  paid  for  notification  and  compensation  for 
animals  slaughtered,  while  failure  to  comply  with  these  regulations  should  be 
punishable  by  a  heavy  penalty. 

Animals,  except  in  emergencies,  should  not  be  slaughtered  or  their  carcasses 
disposed  of  except  on  licensed  and  inspected  premises,  and,  in  all  cases  of  ani- 
mals slaughtered  otherwise  than  by  butchers  in  the  ordinary  course  of  their 
business,  a  veterinary  should  inspect  the  carcasses  and  give  a  certificate  of  the 
cause  of  death  or  disease,  stating  the  uses  to  which  the  carcass  may  be  put, 
a  copy  of  the  certificate  to  be  forwarded  to  the  board  of  agriculture  as  well  as 
to  the  medical  officer  of  health. 

Information  should  be  furnished  to  factory  and  market  officials;  no  butcher 
or  knacker  should  purchase  the  carcass  without  having  seen  the  certificate. 


APPENDIX  A.— RULES  AND   REGULATIONS   IN  THE 
UNITED  STATES. 

UNITED  STATES:  TREASURY  DEPARTMENT  AND  DEPARTMENT 
OF  AGRICULTURE  JOINT  ORDER  NO.  1.  REGULATIONS  GOV- 
ERNING THE  CERTIFICATION  AND  DISINFECTION  OF  HIDES, 
FLESHINGS,  HIDE  CUTTINGS,  PARINGS,  AND  GLUE  STOCK, 
SHEEPSKINS  AND  GOATSKINS  AND  PARTS  THEREOF,  HAIR, 
WOOL,  AND  OTHER  ANIMAL  BY-PRODUCTS,  HAY,  STRAW,  FOR- 
AGE, OR  SIMILAR  MATERIAL  OFFERED  FOR  ENTRY  INTO  THE 
UNITED  STATES,  1916. 

[Effective  January  1,  1917.] 

Washington,  D.  C,  October  21,  1916. 
Under  authority  of  the  act  of  Congress  approved  October  3,  1913,  entitled 
"An  act  to  reduce  tariff  duties  and  to  provide  revenue  for  the  Government, 
and  for  other  purposes  "  (38  Stat.,  114),  and  the  act  of  Congress  approved  Feb- 
ruary 2,  1903,  entitled  "An  act  to  enable  the  Secretary  of  Agriculture  to  more 
effectually  suppress  and  prevent  the  spread  of  contagious  and  infectious  dis- 
eases of  live  stock,  and  for  other  purposes  "  (32  Stat.,  791),  the  following  regu- 
lations are  issued  for  the  purpose  of  preventing  the  introduction  of  anthrax, 
foot-and-mouth  disease,  and  rinderpest  from  a  foreign  country  into  the  United 
States. 

Regulation  I. 

HIDES    AND    SKINS. 

Section  1.  All  hides  of  neat  cattle,  calfskins,  buffalo  hides,  sheepskins,  goat- 
skins, and  deerskins  offered  for  entry  into  the  United  States  from  any  foreign 
country  (except  abattoir  and  hard,  sun-dried  hides  and  skins  as  hereinafter  pro- 
vided) must  be  accompanied  by  a  certificate  signed  by  the  United  States  con- 
sular officer  of  the  district  from  which  such  hides  or  skins  are  shipped  or  by  a 
certificate  issued  by  the  chief  of  the  veterinary  service  or  the  duly  authorized 
sanitary  inspector  of  the  country  from  which  such  hides  or  skins  are  shipped, 
authenticated  by  the  said  United  States  consular  officer,  stating  that  anthrax  is 
not  prevalent,  and  that  neither  foot-and-mouth  disease  nor  rinderpest  exists  in 
such  district,  or  by  a  certificate  signed  by  the  said  consular  officer  showing  that 
such  hides  or  skins  have  been  disinfected  by  immersion  for  not  less  than  24 
hours  in  a  1  to  1,000  bichloride  of  mercury  solution. 

Sec.  2.  If  such  hides  or  skins  (other  than  abattoir  and  hard,  sun-dried  hides 
and  skins)  offered  for  entry  into  the  United  States  are  certified,  as  required  by 
section  1,  to  be  from  a  district  where  anthrax  is  not  prevalent,  but  in  which 
either  foot-and-mouth  disease  or  rinderpest  exists,  they  will  be  admitted  if 
certified  by  the  United  States  consular  officer  of  the  district  from  which  shipped 
to  have  been  disinfected  by  immersion  for  not  less  than  30  minutes  either  in  a 
1  to  1,000  bichloride  of  mercury  solution  or  in  a  5  per  cent  solution  of  car- 
bolic acid. 
126 


ANTHRAX  AS  AN    OCCUPATIONAL   DISEASE APPENDIX   A.        127 

Sec.  3.  Such  hides  or  skins  (other  than  abattoir  and  hard,  sun-dried  hides 
and  skins),  if  packed  in  bales  the  exterior  surface  of  each  of  which  is  thor- 
oughly whitewashed  under  consular  supervision  prior  to  shipment,  may  be 
imported  without  previous  disinfection  upon  the  conditions  that  they  will  be 
disinfected  at  the  owner's  expense  after  arrival  at  destination  in  the  United 
States;  that  the  destination  is  a  tannery  having  proper  facilities  for  disinfect- 
ing the  same ;  that  they  will  move  from  the  port  of  entry  only  under  customs 
seal ;  and  that  they  will  be  disinfected  at  destination  under  the  supervision  of 
the  Bureau  of  Animal  Industry  (a)  when  certified  as  required  by  section  1  to 
be  from  a  district  where  anthrax  is  not  prevalent  by  immersion  in  a  5  per  cent 
solution  of  carbolic  acid  or  a  2  per  cent  solution  of  chloride  of  lime  or  a  1  to 
5,000  solution  of  bichloride  of  mercury,  with  not  less  than  24  hours'  exposure ;  or 
(6)  when  not  certified  in  any  of  the  forms  aforesaid  by  immersion  in  a  1  to 
1,000  bichloride  of  mercury  solution  with  not  less  than  48  hours'  exposure,  or  in 
a  1  to  5,000  bichloride  of  mercury  solution  with  not  less  than  6  days'  exposure 
plus  not  less  than  5  days  in  lime  of  the  usual  strength  for  dehairing. 

Sec.  4.  Hard,  sun-dried  hides  and  skins  may  be  imported  without  disinfec- 
tion if  certified  as  required  in  section  1  to  be  from  a  district  or  districts  where 
anthrax  is  not  prevalent,  if  each  bale  or  hide  is  distinctly  marked  for  identifi- 
cation, each  shipment  showing  invoice  number,  names,  and  addresses  of  con- 
signees and  consignor  as  such  hard  sun-dried  hides  and  skins  so  certified 
showing  freedom  from  anthrax  can  be  considered  as  having  been  disinfected  by 
the  process  of  curing  and  need  not  be  submitted  to  any  further  treatment,  or 
such  hides  or  skins  may  be  imported  without  being  certified  to  be  from  a  dis- 
trict where  anthrax  is  not  prevalent  if  accompanied  by  a  consular  certificate 
showing  them  to  have  been  disinfected  prior  to  shipment  by  immersion  for  not 
less  than  24  hours  in  a  1  to  1,000  bichloride  of  mercury  solution,  or  such  hides 
and  skins  may  be  imported  without  any  certification  upon  the  conditions  pre- 
scribed in  section  3  for  importations  to  be  disinfected  at  destinaton  in  the 
United  States  by  immersion  in  a  1  to  1,000  bichloride  of  mercury  solution  with 
not  less  than  48  hours'  exposure,  or  in  a  1  to  5,000  bichloride  of  mercury  solu- 
tion with  not  less  than  6  days'  exposure  plus  not  less  than  5  days  in  lime  of 
the  usual  strength  for  dehairing. 

Regulation  II. 

ABATTOIR   HIDES   AND    SKINS. 

Abattoir  hides  and  skins  taken  from  animals  slaughtered  in  Sweden,  Nor- 
way, Australia,  New  Zealand,  Great  Britain,  Uruguay,  and  Argentina,  when 
accompanied  by  a  certificate  of  an  official  veterinarian  of  the  country  where  such 
animals  were  slaughtered,  showing  that  such  hides  or  skins  were  taken  from 
animals  free  from  disease  at  the  time  of  slaughter,  may  be  imported  into  the 
United  States  without  disinfection. 

Regulation  III. 

GLUE    STOCK. 

Fleshings,  hide  cuttings  and  parings,  or  glue  stock  shall  be  subject  to  disin- 
fection and  certification  under  the  requirements  of  these  regulations  the  same 
as  hides  and  skins,  except  that  such  fleshings,  hide  cuttings  and  parings,  or 
glue  stock  may  be  imported  without  disinfection  if  shown  by  a  consular  invoice 
used  upon  entry  or  by  a  consular  certificate  to  have  been  sterilized  by  heat 
(not  less  than  200°  F. )  or  by  acidulation,  or  to  have  been  lime  dried  after 
42806°— Bull.  205—17 9 


128  BULLETIN"    OF    THE   BUREAU    OF    LABOR   STATISTICS. 

soaking  for  not  less  than  7  days  in  a  strong  lime  wash  made  by  slaking  quick- 
lime in  water  in  such  proportion  as  to  be  of  a  creamy  consistency,  or  to  have 
been  dried,  by  exposure  to  the  action  of  the  sun  and  air  for  a  sufficient  time  to 
render  each  piece  of  the  hardness  of  a  sun-dried  hide,  provided  the  consignee 
or  his  agent  files  a  satisfactory  bond  or  agreement  that  said  materials  and 
containers  will  be  handled  or  sterilized  in  a  manner  acceptable  to  the  Bureau 
of  Animal  Industry  before  distribution  from  the  factory  or  establishment  to 
which  consigned. 

Regulation  IV. 

BONES,    HOOFS,    AND    HOBNS. 

Section  1.  Bones,  hoofs,  and  horns  which  are  clean,  dry,  and  free  from 
pieces  of  hide,  flesh,  or  sinews  may  be  imported  without  restrictions  other  than 
a  satisfactory  agreement  on  the  part  of  the  consignee  or  his  agent  to  destroy 
or  sterilize  the  bags  or  containers  thereof  at  destination. 

Sec.  2.  Bones,  hoofs,  and  horns  with  pieces  of  hides  or  tendons  attached  and 
also  horn  piths  either  will  be  subject  to  the  requirements  of  Regulation  III 
or  may  be  forwarded  to  a  factory  or  other  establishment  in  sealed  cars  after 
the  bags  or  containers  have  been  sprayed  with  lime  wash  under  the  supervision 
of  an  inspector  of  the  Bureau  of  Animal  Industry,  provided  the  consignee  or 
his  agent  files  a  satisfactory  bond  or  agreement  that  such  materials  will  be 
sterilized  in  an  acceptable  manner  before  distribution  from  the  factory  or  other 
establishment  to  which  shipped,  and  that  the  bags  or  containers  thereof  will 
be  sterilized  or  destroyed. 

Regulation  V. 

WOOL    AND    TTATR. 

Section  1.  Clipped  wool  may  be  imported  in  bales  if  accompanied  by  an 
affidavit  of  a  competent  authority  of  the  district  from  which  the  wool  is 
shipped,  authenticated  by  the  United  States  consul  at  the  port  of  shipment, 
designating  the  bales  by  their  markings,  indicating  the  consignor,  consignee, 
and  number  of  the  invoice,  and  stating  that  all  the  wool  contained  in  such 
bales  was  clipped  from  live  animals  free  from  foot-and-mouth  disease,  rinder- 
pest, and  anthrax,  and  that  the  same  has  not  been  exposed  to  the  infection 
of  these  diseases. 

Sec.  2.  Picked  or  pulled  wool  or  hair  may  be  imported  if  accompanied  by  a 
declaration  of  the  exporter,  authenticated  by  the  United  States  consul  at  the 
port  of  shipment,  to  the  effect  that  such  wool  or  hair,  designated  in  the  manner 
provided  in  section  1  of  this  regulation  for  clipped  wool,  came  from  animals  free 
from  anthrax.  The  consignee  or  owner  of  such  wool  or  hair  or  his  agent  shall 
be  required  to  file  a  satisfactory  bond  or  agreement  assuring  proper  facilities 
of  disinfection  at  the  establishment  to  which  the  shipment  is  consigned,  and 
that  all  of  such  wool  or  hair  will  be  disinfected  or  sterilized  by  proper  exposure 
to  a  temperature  of  not  less  than  200°  F.  prior  to  any  transfer  or  reshipment 
from  such  establishment.  If  such  wool  or  hair,  when  offered  for  entry,  is  un- 
accompanied by  the  above-mentioned  declaration,  its  entry  will  be  permitted 
upon  the  condition  that  the  consignee  or  owner  thereof  or  his  agent  files  a  satis- 
factory bond  or  agreement  assuring  proper  facilities  for  disinfection  at  the 
establishment  to  which  the  shipment  is  consigned,  and  that  all  of  such  wool  or 
hair  will  be  disinfected  or  sterilized  by  proper  exposure  to  a  temperature  of 
not  less  than  212°  F.  for  at  least  15  minutes  prior  to  any  transfer  or  reship- 
ment from  such  establishment. 


ANTHRAX   AS  AN   OCCUPATIONAL  DISEASE APPENDIX   A.        129 

Sec.  3.  Importation  of  abattoir  pulled  wool  will  be  permitted  without  restric- 
tions from  any  country  maintaining  a  veterinary  inspection  system  ascertained 
by  the  Secretary  of  Agriculture  and  certified  by  him  to  the  Secretary  of  the 
Treasury,  from  time  to  time,  to  be  the  substantial  equivalent  of  the  veterinary 
inspection  system  maintained  by  the  United  States,  when  accompanied  by  a 
certificate  signed  by  an  official  veterinary  inspector  of  such  country  to  the 
effect  that  said  wool  was  procured  from  sheep  slaughtered  therein  under 
Government  inspection,  and  that  in  the  process  of  wet  pulling  and  drying  it 
has  been  subjected  to  a  temperature  of  not  less  than  200°  F.  Such  certificate 
must  indicate  the  number  of  bales,  marks,  names,  and  addresses  of  consignor 
and  consignee,  district  of  origin,  date  of  shipment,  invoice  number,  and  vessel 
transporting. 

Sec.  4.  All  wool  and  hair  unaccompanied  by  certificates,  affidavits,  and  decla- 
rations herein  provided,  when  permitted  to  be  entered  without  such  certificates, 
affidavits,  and  declarations,  must  be  shipped  from  port  of  entry  to  destination 
in  sealed  cars  after  the  bales  or  bundles  have  been  whitewashed  at  such  port 
of  entry  under  the  supervision  of  an  inspector  of  the  Bureau  of  Animal  In- 
dustry, and  the  destination  of  such  wool  or  hair  must  be  a  factory  or  estab- 
lishment having  satisfactory  facilities  for  sterilizing  or  disinfecting  the  same 
in  the  manner  provided  by  these  regulations  or  as  may  be  directed  by  the  Chief 
of  the  Bureau  of  Animal  Industry.  The  consignee,  owner,  or  his  agent  will  be 
required  to  file  a  satisfactory  bond  or  agreement  to  fulfill  all  requirements  as 
to  shipment  and  disinfection  or  sterilization. 

Regulation   VI. 

HAT,    STBAW,   ETC.,   AND   MEATS   PACKED   IN    HAY   OB   STKAW. 

Section  1.  On  account  of  the  existence  of  foot-and-mouth  disease  in  the 
countries  of  continental  Europe  and  South  America,  and  the  impracticability 
of  disinfecting  hay  and  straw  used  as  the  packing  on  meats  offered  for  entry 
without  injuring  the  meats  for  food  purposes,  the  entry  into  the  United  States 
from  any  of  those  countries  of  any  meats  packed  in  hay  or  straw  is  prohibited. 

Sec.  2.  Bran,  middlings,  and  mill  feed  may  be  imported  from  Argentina  with- 
out being  disinfected  as  prescribed  in  section  4  if  accompanied  by  a  certificate 
signed  by  the  United  States  consul  of  the  district  from  which  shipped  showing 
that  such  bran,  middlings,  or  mill  feed  was  conveyed  by  chutes  directly  from 
the  mill  in  which  produced  into  the  vessels  transporting  the  same  to  the  United 
States. 

Sec.  3.  Because  of  lack  of  danger  of  the  communication  of  disease  through 
the  importation  of  hay,  straw,  forage,  and  similar  materials,  including  bran, 
middlings,  or  other  mill  feed  originating  in  and  transported  directly  from 
Great  Britain,  Ireland,  the  Channel  Islands,  Canada,  and  Mexico,  such  articles 
may  be  imported  into  the  United  States  from  these  countries  as  long  as  the 
above  condition  continues  to  exist  without  being  disinfected  as  prescribed  in 
section  4. 

Sec.  4.  Except  as  otherwise  provided  in  this  regulation  all  hay,  straw,  for- 
age, or  similar  materials,  including  bran,  middlings,  or  other  mill  feed,  offered 
for  importation  from  any  foreign  country  shall  be  disinfected  in  the  manner 
prescribed  by  the  Chief  of  the  Bureau  of  Animal  Industry,  at  the  expense  of 
the  owner,  before  being  unloaded  from  the  vessel  or  conveyance  bringing  the 
same  into  any  port  of  the  United  States,  and  when  unloaded  and  landed  shall 
be  stored  and  held  in  quarantine  for  a  period  of  not  less  than  three  months 


130  BULLETIN    OF    THE   BUREAU    OF   LABOR    STATISTICS. 

at  some  place  acceptable  to  the  Chief  of  the  Bureau  of  Animal  Industry  and 
under  directions  prescribed  by  him. 

Regulation  VII. 

CANADA. 

Because  of  the  lack  of  danger  of  the  introduction  of  disease  into  the  United 
States  through  the  importation  of  the  articles  enumerated  in  these  regulations 
originating  in  and  transported  directly  from  Canada,  such  articles  may  be  im- 
ported from  Canada  as  long  as  the  above  condition  continues  to  exist  without 
being  disinfected  or  certified  as  prescribed  by  these  regulations. 

Regulation  VIII. 

PEODUCTS    FROM    DISEASED    ANIMALS. 

Importation  into  the  United  States  of  any  hides,  skins,  fleshings,  hide  cut- 
tings, parings,  and  glue  stock,  hair,  wool,  or  other  animal  products  covered  by 
these  regulations,  taken  or  removed  from  animals  affected  with  anthrax,  foot- 
and-mouth  disease,  or  rinderpest,  is  prohibited. 

Regulation    IX. 

DISINFECTION  OF  CABS,  BOATS,  OTHEK  VEHICLES,  AND  PP.EMISES. 

Cars,  boats,  other  vehicles,  yards,  and  premises  which  have  been  used  in  the 
transportation,  handling,  and  storing  of  uncertified  or  nondisinfected  imported 
hides,  skins,  and  parts  thereof,  hair,  wool,  and  other  animal  by-products,  hay, 
straw,  forage,  or  similar  material,  permitted  entry  subject  to  disinfection,  shall 
be  cleaned  and  disinfected,  under  the  supervision  of  the  Bureau  of  Animal  In- 
dustry, subject  to  the  conditions  and  in  accordance  with  the  requirements  of 
the  regulations  of  the  United  States  Department  of  Agriculture  contained  in 
B.  A.  I.  Order  245,  governing  the  disinfection  of  cars,  boats,  other  vehicles, 
yards,  and  premises  used  in  interstate  movement  of  live  stock,  except  that  all 
such  cars,  boats,  other  vehicles,  yards,  and  premises,  storage  places  used  in 
the  transportation,  handling,  and  storing  of  any  of  said  articles  uncertified  for 
nonprevalenee  of  anthrax,  or  which  have  not  been  disinfected  against  anthrax, 
shall  be  disinfected  with  a  1  to  1,000  bichloride  of  mercury  solution.  The  per- 
mitted disinfectants  specified  in  the  said  B.  A.  I.  Order  245  may  be  used  in 
disinfection  against  the  other  communicable  diseases. 

PRIOR    ORDERS    ANNULLED. 

Treasury  Department  Circular  No.  23,  dated  May  2,  1910,  and  all  amend- 
ments thereto,  and  B.  A.  I.  Order  129,  dated  October  4,  1904,  and  all  amend- 
ments thereto,  shall  cease  to  be  effective  on  and  after  January  1,  1917,  on  and 
after  which  date  this  order,  which  for  purposes  of  identification  is  designated 
as  United  States  Treasury  Department  and  Department  of  Agriculture  Joint 
Order  No.  1,  shall  become  and  be  effective  until  otherwise  ordered. 

(Signed)  Wm,    P.    M alburn, 

Acting  Secretary  of  the  Treasury. 
D.   F.   Houston, 
Secretary  of  Agriculture. 


ANTHRAX    AS   AX    OCCUPATIONAL    DISEASE APPENDIX    A.        131 

MASSACHUSETTS:    RULES    AND    REGULATIONS    SUGGESTED    FOR 
THE  PREVENTION  OF  ANTHRAX,  1916.1 

PREAMBLE. 

Anthrax  may  be  transmitted  to  man  by  infected  hides,  skins,  wool,  horse 
hair,  cow  hair,  goat  hair,  pigs'  bristles  or  pigs'  wool,  as  well  as  by  dried  blood, 
bones,  and  other  animal  products.  The  bacillus  of  anthrax  soon  dies  out 
when  dried  at  the  ordinary  temperature,  but  the  spores  of  the  disease  may 
remain  active,  under  favorable  circumstances,  for  many  years.  These  spores, 
inclosed  in  blood  clots,  dried  and  caked  on  the  hair,  skin,  or  wool,  are  the 
usual  sources  of  infection,  owing  to  the  clots  breaking  up  into  dust.  The  dust 
arising  in  the  handling,  sorting,  and  manipulation  of  the  animal  products 
readily  finds  its  way  into  the  lungs  in  breathing,  or  is  swallowed  in  the  act 
of  eating  or  drinking.  More  often,  however,  the  dust  finds  its  way  into  broken 
skin  by  cuts,  bruises,  or  scratched  pimples.  The  result  of  this  infection  is 
anthrax.  Anthrax,  therefore,  is  chiefly  a  dust  disease.  (It  can  be  caused 
by  eating  diseased  meat  and  by  the  bite  of  an  insect  which  has  fed  upon 
infected  carcasses  or  other  material.)  While  the,  danger  of  anthrax  is  greatest, 
according  to  all  statistics,  in  the  manipulation  of  animal  products  imported 
from  China,  Russia,  and  Siberia,  nevertheless  the  disease  is  so  widely  dis- 
tributed that  in  no  country  is  it  unknown.  Consequently,  the  precautions 
which  are  most  necessary  where  hides,  skins,  hair,  and  wool  from  the.  coun- 
tries named  are  handled  can,  with  advantage,  be  applied  to  products  from 
other  countries.  In  the  United  States  there  is  no  interstate,  quarantine  law 
nor  disinfection  regulation  against  anthrax. 
,  Protection  against  anthrax  can  be  grouped  under  these  headings,  viz. : 

1.  Disinfection  of  the  material. 

2.  The  avoidance  of  dust. 

3.  The  instruction  of  the  workers. 

The  experience  of  countries  where  anthrax  has  been  more  prevalent  than 
it  has  been  in  this  country  shows  (1)  that  wool  or  hair  can  be  readily  disin- 
fected by  steam  without  injury  to  the  material,  and  (2)  that  hides  and  skins 
can  be  disinfected  without  damage  to  these  articles  and  without  injury  to 
subsequent  manufacturing  processes. 

The  following  rules  and  regulations  shall  apply  to  all  establishments  where 
hides,  skins,  fur,  horse  hair,  bristles,  wool,  horns,  bones,  or  other  animal  prod- 
ucts liable  to  be  infected  with  anthrax  are  handled. 

For  the  enforcement  of  these  rules  and  regulations  all  products  or  parts 
of  animals  shall  be  considered  in  a  raw  state  unless  they  have  undergone  a 
treatment  as  follows : 

Hides  and  skins — tanning. 

Wool — scouring. 

Horse  hair,  fur,  and  hog  bristles — bleaching. 

Horns  and  bune — boiling  for  two  hours,  or  treatment  with  a  strong  antiseptic. 

The  following  industries  shall  be  considered  dangerous  within  these  rules 
and  regulations,  and  they  shall  apply  in  ;i  special  manner  in  those  departments 
where  these  processes  are  carried  on.  viz. : 

1.  The  unpacking,  unloading,  or  other  handling,  when  dry,  or  before  disin- 
fection of  the  material. 

2.  The  preparation  of  horse  hair. 

3.  Tawing,   tanning,   and  fur  dressing. 

4.  The  pulling,  scouring,  and  sorting  of  wool. 


1  Massachusetts  Board  of  Labor  and  Industries,  Industrial  Bulletin  No.  6. 


132  BULLETIN    OF    THE   BUREAU    OF    LABOR   STATISTICS. 

DISINFECTION. 

All  foreign1  hides,  skins,  horse  hair,  cow  hair  or  goat  hair,  pigs'  bristle,  and 
pigs'  wool,  before  they  are  manipulated  in  any  factory  or  establishment  in 
this  State,  shall  be  disinfected  (unless  exempted  as  hereinafter  provided)  at 
the  choice  of  the  manufacturer  in  one  of  the  following  prescribed  ways : 

A.   Hides  and  Skins. 

(1)  By  the  Seymour-Jones  method,  viz:  To  1  pound  of  perchloride  of  mer- 
cury add  500  gallons  of  water,  and  to  this  mixture  add  5  gallons  of  formic 
acid  (commercial  50  per  cent  strength).  In  this  bath  steep  the  material  for 
24  hours ;  or, 

(2)  By  the  Schattenfroh  method,  viz:  In  a  2  per  cent  hydrochloric  acid  solu- 
tion to  which  10  per  cent  of  common  salt  has  been  added,  steep  the  material 
for  a  few  days.  A  quicker  method  can  be  used  by  substituting  a  1  per  cent  solu- 
tion of  hydrochloric  acid  and  8  per  cent  of  salt,  provided  the  temperature  of  the 
solution  is  maintained  at  40°  C.   (104°  F.)  for  a  period  of  six  hours. 

B.  Hair,  Bristles,  and  Pigs'  Wool. 

(1)  By  letting  a  current  of  steam  act  on  the  material  for  not  less  than  one- 
half  hour  at  a  pressure  of  17  pounds  (0.15  above  atmospheric  pressure)  ;  or, 

(2)  By  boiling  for  at  least  one-quarter  of  an  hour  in  a  solution  containing 
2  per  cent  of  permanganite  of  potassium,  and  subsequent  bleaching  with  a  3  or 
4  per  cent  solution  of  sulphurous  acid ;  or, 

(3)  By  boiling  in  water  for  not  less  than  two  hours. 

Exemptions. 

The  disinfection  by  the  manufacturer  may  be  dispensed  with  if  he  presents 
proof  in  writing  stating  that  the  material  has  been  disinfected  in  accordance 
with  the  requirements  of  the  United  States  Treasury  Department  or  of  the 
Massachusetts  State  Department  of  Health. 

The  manufacturer  shall  not  be  required  to  disinfect  white  bristles  which  he 
subjects  to  a  subsequent  bleaching  process  before  further  manipulation,  or 
which  he  has  bought  already  bleached  (so-called  French  bristles)  and  which 
have  been  kept  apart  from  nondisinfected  material. 

Exemption  from  the  requirements  of  section  B  may  be  authorized  by  the 
State  Board  of  Labor  and  Industries  for  those  materials  that,  according  to 
present  experience,  would  be  seriously  damaged,  or  for  those  materials  that 
can  be  certified  to  as  having  already  undergone  an  equally  effective  disinfection 
in  the  country  or  State  from  which  they  have  been  exported. 

Prior  to  disinfection  prescribed  by  these  rules  and  regulations  only  such  steps 
as  are  indispensable  to  the  examination  of  the  quality  of  the  material,  to  the 
prevention  of  their  being  spoiled,  and  to  the  preparation  and  the  execution  of 
the  disinfection  are  permitted  in  relation  to  material  required  to  be  disin- 
fected, e.  g.,  unpacking  and  preparing  for  disinfection. 

The  stock  of  nondisinfected  materials  which  are  required  to  be  disinfected, 
or  which  are  exempted  from  disinfection,  shall  be  stored  in  separate,  rooms  and 
kept  apart  from  the  stock  that  has  been  disinfected.  Access  to  this  room  should 
be  restricted  as  much  as  possible  so  as  to  avoid  unnecessary  exposure  of 
workmen. 

Records. 

The  employer  shall  keep  a  record  of  the  skins,  hides,  hair,  bristles,  wool,  and 
other  material  mentioned  in  these  rules  and  regulations,  in  such  a  manner  that 
the  quantity,  the  source  of  supply,  and,  so  far  as  is  known,  the  origin  of  the 
merchandise  received,  as  well  as  the  time  and  the  method  of  disinfection,  or  the 

1  Also  domestic  whenever  anthrax  is  prevalent  in  the  locality  from  which  the  material 
has  been  exported. 


ANTHRAX   AS  AN   OCCUPATIONAL   DISEASE APPENDIX   A.       133 

reason  for  its  omission,  are  clearly  set  forth.     Such  records  shall  be  accessible 
to  the  State  Board  of  Labor  and  Industries  or  its  representatives. 

SANITATION   OF  WORKSHOPS. 

Floors. — In  those  parts  of  the  establishment  where  material  capable  of  trans- 
mitting anthrax  is  stored  or  manufactured  the  floors  shall  have  a  waterproof 
covering  or  other  suitable  material  that  permits  the  ready  washing  of  such 
floors.  The  floors  of  these  departments  should  be  washed  daily  if  the  workroom 
is  dusty  or  if  cases  of  anthrax  have  occurred  recently  at  the  establishment. 

Walls  and  ceiling. — The  walls  and  ceiling  of  such  workshop  or  room,  unless 
covered  with  a  smooth  washable  coating  or  oil  painting,  should  be  washed  fre- 
quently with  a  disinfectant  solution.  If  whitewash  is  used  this  coating  should 
be  renewed  on  the  outbreak  of  cases  of  anthrax  among  workmen  employed  in 
that  establishment. 

Tables,  workbenches  and  seats. — These  articles  should  be  washed  twice  a 
week  with  a  disinfectant  solution,  especially  if  cases  of  anthrax  have  occurred 
recently  in  the  establishment. 

Ventilation. — The  workroom  shall  be  well  aired  twice  daily  by  means  of 
open  windows,  for  at  least  half  an  hour,  viz,  during  noonday  meal  hour  and 
after  the  day's  work  has  been  finished,  or  before  it  has  begun  again.  No  work- 
man should  be  permitted  to  remain  in  the  room  during  this  period. 

Dust  removal. — In  all  workrooms  in  which  dust  is  a  factor  there  shall  be 
an  adequate  exhaust  system  installed  capable  of  removing  the  dust  at  its  origin 
and  conveying  it  to  a  suitable  receptacle  for  subsequent  destruction. 

It  is  recommended  that  hides  and  skins  be  submitted  to  the  ordinary  "wet 
salting"  process  immediately  after  flaying ;  or  if  cured  by  drying,  that  the  hides 
and  skins  be  converted  back  to  the  "  wet  salted  "  state  by  the  formic-mercury 
processes  as  soon  as  possible. 

In  horsehair  factories  and  horsehair  dressing,  the  sorting  and  hackling  shall 
not  be  done  except  in  special  workrooms  separate  from  the  other  workroom. 
The  dust  created  shall  be  collected  and  destroyed. 

Carding  and  dust-extracting  machinery  as  well  as  mixing,  willowing,  and 
hackling  machines,  shall  be  closed  over  and  provided  with  an  adequate  and 
effective  dust  exhaust  system.  The  dust  shall  be  collected  in  a  dust  chamber 
and  burned. 

The  treatment  of  wool,  horsehair,  hog  bristles,  and  furs  shall  take  place 
whenever  possible  in  closed  vessels.  In  those  operations,  such  as  opening  of 
bales  or  beating,  which  can  not  take  place  in  closed  vessels,  the  process  shall 
be  carried  on  in  such  a  way  as  to  allow  the  collecting  of  the  refuse  and  its  sub- 
sequent destruction. 

PERSONAL  PRECAUTIONS. 

Printed  notices  issued  by  the  State  Board  of  Labor  and  Industries  shall  be 
kept  posted  in  a  conspicuous  place  in  each  department,  setting  forth  the  dangers 
of  anthrax  infection,  the  early  signs  and  symptoms  of  the  disease,  and  the 
precautions  that  shall  be  taken  in  order  to  avoid  this  infection. 

Any  employee  who  is  suffering  from  a  cut,  scratch,  pimple,  or  crack  of  the 
skin  that  has  not  healed  readily  shall  report  the  same  to  the  person  in  charge 
or  to  factory  physician. 

Employers  shall  furnish  to  employees  impermeable  aprons  and  leggings  (or 
rubber  boots)  in  all  operations  where  the  body  is  liable  to  come  in  contact  with 
the  water  used  in  tanning,  scouring,  boiling,  or  bleaching  of  animal  product. 

Employees  shall  wear  a  suitable  respirator  (loose  gauze  cloth  tied  over  nose 
and  mouth  may  be  used)  while  engaged  in  the  dusty  processes  of  handling, 
sorting,  or  of  manufacture. 


134  BULLETIN"    OP    THE   BUREAU    OF    LABOR    STATISTICS. 

Employers  shall  provide  for  the  use  of  employees  overalls  and  gloves  when 
handling  raw  material,  and  neck  protectors  when  carrying  raw  material  on  the 
shoulder.  Raw  material  shall  be  transported  on  carts  or  handbarrows  when- 
ever practicable. 

Employers  shall  see  that  the  materials  provided  for  the  use  of  employees  are 
worn  by  the  persons  for  whom  they  are  intended,  and  that  when  these  articles 
are  not  in  use  they  are  kept  in  a  special  place,  and  that  they  are  disinfected  at 
least  once  a  week. 

Dressing  rooms,  wash  rooms,  and  a  suitable  dining  room  shall  be  provided  and 
fitted  up  outside  the  place  where  dangerous  operations  are  carried  on. 

There  shall  be  provided  an  adequate  supply  of  running  hot  and  cold  water, 
toilets,  washing  and  drinking  facilities,  all  in  accordance  with  the  rules  of  the 
State  Board  of  Labor  and  Industries  on  toilets.  Lockers  shall  be  provided  so 
that  street  clothes  and  work  clothes  may  be  kept  separate  and  apart. 

Employees  shall  not  bring  food  into  the  workroom.  The  eating  of  food  in 
workroom  shall  be  strictly  prohibited. 

Employees  shall  be  required  to  take  off  their  work  clothes  before  entering  the 
dining  room,  and  to  wash  hands,  arms,  neck,  and  face  before  taking  their  meals 
or  leaving  the  premises. 

Employers  shall  keep  posted  in  a  conspicuous  place  in  each  department  a 
notice  legible  to  all  employees  stating — 

1.  The  text  of  these  rules  and  regulations. 

2.  Workshop  regulations  imposing  on  employees  the  following  obligations : 

(a)  To  make  use  of  the  various  working  clothes  and  other  articles  provided 
for  them  by  the  employer. 

( b )  To  make  use  of  the  dressing  room  and  washing  facilities. 

(c)  To  take  the  necessary  measures  for  cleanliness  before  eating  and  before 
leaving  the  workshop. 

(d)  To  bring  no  food  into  the  workroom. 

3.  The  dangers  of  anthrax  infection,  and  the  precautions  that  should  be  taken 
to  avoid  them,  and  the  necessity  of  employees  reporting  at  once  all  skin 
affections. 

4.  Name  and  address  of  physician  in  charge  of  the  medical  service  of  the 
establishment. 

Note. 

The  first  symptom  of  anthrax  is  usually  a  small  inflamed  swelling  like  a  pim- 
ple or  boil.  This  is  often  painless.  In  a  few  days  the  pimple  becomes  black  at 
the  center  and  is  surrounded  by  other  "  pimples."  The  poison  is  now  liable  to 
be  absorbed  into  the  system  and  will  cause  risk  of  life  if  not  removed  by  prompt 
and  effective  treatment.  Early  treatment  is  usually  successful ;  delay  or  neglect 
usually  leads  to  blood  poisoning,  often  to  death. 

NEW  YORK:  STATE  INDUSTRIAL   COMMISSION,  DIVISION   OF 
INDUSTRIAL   HYGIENE,    RECOMMENDATIONS,    1916. 

I.  Every  physician  should  report  at  once  to  the  State  industrial  commission 
every  case  of  anthrax  coming  under  his  care. 

II.  In  every  establishment  where  articles  liable  to  be  infected  with  anthrax 
are  handled  a  competent  physician  should  be  employed. 

III.  In  every  such  establishment  the  employer  should  make  such  special 
provision  for  the  protection  of  his  employees  as  the  commission  shall  deter- 
mine. 

IV.  Every  employee  should  be  required  to  make  use  of  the  means  provided 
for  his  safety  by  the  employer. 


ANTHRAX    AS   AX    OCCUPATIONAL    DISEASE APPENDIX   A.        135 

V.  It  should  be  the  duty  of  the  shop  foreman  or  superintendent  to  enforce 
the  use  by  the  employees  of  the  means  provided  by  the  employer. 

VI.  Attention  of  physicians  and  of  the  public  should  be  called  to  the  dangers 
of  anthrax. 

VII.  Cooperation  with  Federal  and  contiguous  State  authorities  should  be 
maintained  to  prevent  the  entrance  of  infected  materials  into  commerce. 

THE     PHYSICIAN. 

1.  He  should  visit  the  establishment  every  day  and  sign  a  register  showing 
the  time  of  his  visit,  this  register  to  be  subject  to  inspection  by  the  State  indus- 
trial commission. 

2.  He  should  examine  every  workman  at  entrance  upon  employment,  and  as 
often  thereafter  as  necessary.  He  should  instruct  new  employees  individually, 
and  the  others  frequently  in  classes,  in  methods  of  preventing  anthrax. 

3.  He  should  be  provided  with  facilities  for  the  prompt  diagnosis  and  early 
treatment  of  anthrax.  He  should  have  charge  of  the  first-aid  kits,  as  approved 
by  the  commission.  He  should  instruct  foremen  and  others  selected  in  the 
use  of  first  aid. 

4.  He  should  keep  a  record  of  all  examinations  and  of  all  treatments,  such 
record  to  be  subject  to  inspection  by  the  commission.  He  should  report 
promptly  to  the  commission  every  case  of  anthrax,  together  with  a  record  of 
the  source  of  the  infecting  material. 

THE   EMPLOYEE. 

1.  In  factories  the  floors  should  be  of  cement  or  waterproofed  easily  washed 
material.  The  walls  should  be  whitewashed.  When  a  case  of  anthrax  de- 
velops the  floors  should  be  thoroughly  cleaned  and  the  walls  whitewashed. 
Tables,  work  benches,  and  other  articles  coming  in  contact  with  materials 
should  be  washed  as  often  as  necessary  with  a  disinfecting  solution. 

2.  Dressing  rooms,  wash  rooms,  and  lunch  rooms  should  be  provided,  sepa- 
rate from  the  work  rooms.  The  dressing  room  should  be  so  arranged  that  the 
working  clothes  niay  be  kept  separate  from  the  street  clothes.  The  wash 
rooms  should  be  provided  with  basins,  water,  soap,  individual  towels,  etc.,  as 
directed  by  the  industrial  code.    No  food  should  be  allowed  in  the  workrooms. 

3.  Where  dust  is  evolved  in  the  process  special  ventilating  apparatus  should 
be  installed  according  to  the  judgment  of  the  commission. 

4.  To  avoid,  as  much  as  possible,  contact  with  materials,  suitable  clothing, 
waterproof  aprons,  overalls,  shoes,  gloves,  etc.,  should  be  provided  the  work- 
men. 

5.  Notices  in  different  languages  should  be  posted  conspicuously  throughout 
the  workrooms : 

(a)  Requiring  the  use  of  protective  clothing;  requiring  the  use  of  dressing 
rooms  and  wash  rooms ;  forbidding  food  in  workrooms. 

(6)  Warning  of  dangers  of  anthrax;  instructing  as  to  methods  of  avoiding 
it ;  requiring  the  report  to  foremen  of  even  slight  accidents  or  injuries. 

G.  The  foreman  or  superintendent  should  be  held  responsible  for  observance 
of  the  regulations. 

THE     EMPLOYEE. 

1.  He  should  realize  the  danger  of  anthrax  and  the  necessity  of  avoiding 
infection. 

2.  He  should  wear  the  clothing  and  use  the  dressing  rooms,  wash  rooms,  and 
lunch  rooms  provided  by  the  employer.  No  food  should  be  taken  into  the  work- 
rooms. 

3.  He  should  report  at  once  to  the  foreman  even  slight  injuries  and  should 
follow  strictly  directions  of  the  physician. 

4.  He  should  assist  the  foreman  in  enforcing  the  regulations. 


APPENDIX  B.— TEXT  OF  EUROPEAN  REGULATIONS.1 

GREAT  BRITAIN:  REGULATIONS  FOR  HANDLING  DRY  AND  DRY- 
SALTED  HIDES  AND  SKINS  IMPORTED  FROM  CHINA  OR  FROM 
THE  WEST  COAST  OF  INDIA,  1901. 

DUTIES  OF  OCCUPIER. 

1.  Proper  provisions  to  the  reasonable  satisfaction  of  the  inspector  in  charge 
of  the  district  shall  be  made  for  the  keeping  of  the  workmen's  food  and  clothing 
outside  any  room  or  shed  in  which  any  of  the  above-described  hides  or  skins 
are  unpacked,  sorted,  packed,  or  stored. 

2.  Proper  and  sufficient  appliances  for  washing,  comprising  soap,  basins,  with 
water  laid  on,  nailbrushes  and  towels,  shall  be  provided  and  maintained  for 
the  use  of  the  workmen,  to  the  reasonable  satisfaction  of  the  inspector  in  charge 
of  the  district. 

3.  Sticking  plaster  and  other  requisites  for  treating  scratches  and  slight 
wounds  shall  be  kept  at  hand,  available  for  the  use  of  the  persons  employed 

4.  A  copy  of  the  appended  notes  shall  be  kept  affixed  with  the  rules. 

DUTIES  OF  PERSONS  EMPLOYED. 


ght 


5.  No  workman  shall  keep  any  food,  or  any  articles  of  clothing  other  than 
those  he  is  wearing,  in  any  room  or  shed  in  which  any  of  the  above-described 
hides  or  skins  are  handled.  He  shall  not  take  any  food  in  any  such  room  or 
shed. 

6.  Every  workman  having  any  open  cut  or  scratch  or  raw  surface,  however 
trifling,  upon  his  face,  head,  neck,  arm,  or  hand  shall  immediately  report  the 
fact  to  the  foreman,  and  shall  not  work  on  the  premises  until  the  wound  is 
healed  or  is  completely  covered  by  a  proper  dressing  after  being  thoroughly 
washed. 

Note  1.  [States  that  these  rules  must  be  kept  posted  in  conspicuous  places  in 
the  factory,  workshop,  or  other  premises  to  which  they  apply,  where  they  may 
be  conveniently  read  by  the  persons  employed.  Any  person  who  is  bound  to 
observe  them  and  fails  to  do  so,  or  acts  in  contravention  of  them,  is  liable  to 
a  penalty ;  and  in  such  cases  the  occupier  is  also  liable  to  a  penalty  unless  he 
proves  that  he  has  taken  all  reasonable  means,  by  publishing  and,  to  the  best 
of  his  power,  enforcing  them,  to  prevent  the  contravention  or  noncompliance. 
A  printed  copy  must  be  supplied  by  the  occupier  to  any  person  affected  by 
them  if  such  person  applies  for  it.  Pulling  down,  injuring,  or  defacing  any 
copy  so  posted  is  punished  by  a  fine  not  exceeding  £5  ($24.33).] 

Note  2.  [Is  an  earlier  and  less  complete  form  of  the  note  shown  on  page  140.] 
Note  3. — Suitable  overalls,  protecting  the  neck  and  arms,  as  well  as  ordinary 
clothing,  add  materially  to  the  safety  of  the  workmen,  and  should  be  provided 
and  worn,  where  practicable,  if  dangerous  hides  are  handled.  They  should  be 
discarded  on  cessation  of  work.  Similarly,  for  the  protection  of  the  hands, 
gloves  should  be  provided  and  worn  where  the  character  of  the  work  permits. 

1  From  monthly  bulletin  of  the  International  Labor  Office. 
136 


ANTHRAX  AS  AN  OCCUPATIONAL  DISEASE APPENDIX  B.  137 

GREAT  BRITAIN:  SORTING,  WILLEYING  [WILLOWING],  WASHING, 
COMBING,  AND  CARDING  WOOL,  GOAT  HAIR,  AND  CAMEL  HAIR, 
AND  PROCESSES  INCIDENTAL  THERETO,  1905. 

DEFINITION. 

For  the  purpose  of  regulations  2,  3  and  18,  opening  of  wool  or  hair  means 
the  opening  of  the  fleece,  including  the  untying  or  cutting  of  the  knots,  or,  if 
the  material  is  not  in  the  fleece,  the  opening  out  for  looking  over  or  classing 
purposes. 

DUTIES   OF   OCCUPIERS. 

1.  No  bale  of  wool  or  hair  of  the  kinds  named  in  the  schedules  shall  be  opened 
for  the  purpose  of  being  sorted  or  manufactured,  except  by  men  skilled  in 
judging  the  •  condition  of  the  material. 

No  bale  of  wool  or  hair  of  the  kinds  named  in  schedule  A  shall  be  opened 
except  after  thorough  steeping  in  water. 

2.  No  wool  or  hair  of  the  kinds  named  in  schedule  B  shall  be  opened  except 
(a)  after  steeping  in  water,  or  (b)  over  an  efficient  opening  screen,  with 
mechanical  exhaust  draft,  in  a  room  set  apart  for  the  purpose,  in  which  no 
other  work  than  opening  is  carried  on. 

For  the  purpose  of  this  regulation,  no  opening  screen  shall  be  deemed  to  be 
efficient  unless  it  complies  with  the  following  conditions : 

(a)  The  area  of  the  screen  shall,  in  the  case  of  existing  screens,  be  not  less 
than  11  square  feet,  and  in  the  case  of  screens  hereafter  erected  be  not  less 
than  12  square  feet,  nor  shall  its  length  or  breadth  be  less  than  3£  feet. 

(6)  At  no  point  of  the  screen  within  18  inches  from  the  center  shall  the 
velocity  of  the  exhaust  draft  be  less  than  100  linear  feet  per  minute. 

3.  All  damaged  wool  or  hair  or  fallen  fleeces  or  skin,  wool  or  hair,  if  of  the 
kinds  named  in  the  schedules,  shall,  when  opened,  be  damped  with  a  disin- 
fectant and  washed  without  being  willowed. 

4.  No  wool  or  hair  of  the  kinds  named  in  schedules  B  or  C  shall  be  sorted 
except  over  an  efficient  sorting  board,  with  mechanical  exhaust  draft,  and 
in  a  room  set  apart  for  the  purpose,  in  which  no  work  is  carried  on  other 
than  sorting  and  the  packing  of  the  wool  or  hair  sorted  therein. 

No  wool  or  hair  of  the  kinds  numbered  (1)  and  (2)  in  schedule  A  shall  be 
sorted  except  in  the  damp  state  and  after  being  washed. 

No  damaged  wool  or  hair  of  the  kinds  named  in  the  schedules  shall  be  sorted 
except  after  being  washed. 

For  the  purpose  of  this  regulation,  no  sorting  board  shall  be  deemed  to  be 
efficient  unless  it  complies  with  the  following  conditions : 

The  sorting  board  shall  comprise  a  screen  of  open  wirework,  and  beneath 
it  at  all  parts  a  clear  space  not  less  than  3  inches  in  depth.  Below  the  center 
of  the  screen  there  shall  be  a  funnel,  measuring  not  less  than  10  inches  across 
the  top,  leading  to  an  extraction  shaft,  and  the  arrangements  shall  be  such  that 
all  dust  falling  through  the  screen  and  not  carried  away  by  the  exhaust  can 
be  swept  directly  into  the  funnel.  The  draft  shall  be  maintained  in  constant 
efficiency  while  the  sorters  are  at  work,  and  shall  be  such  that  not  less  than 
75  cubic  feet  of  air  per  minute  are  drawn  by  the  fan  from  beneath  each  sort- 
ing board. 

5.  No  wool  or  hair  of  the  kinds  named  in  the  schedules  shall  be  willowed 
except  in  an  efficient  willowing  machine,  in  a  room  set  apart  for  the  purpose, 
in  which  no  work  other  than  willowing  is  carried  on. 


138  BULLETIN"   OF    THE   BUREAU    OF    LABOR   STATISTICS. 

For  the  purpose  of  this  regulation,  no  willowing  machine  shall  be  deemed  to 
be  efficient  unless  it  is  provided  with  mechanical  exhaust  draft  so  arranged 
as  to  draw  the  dust  away  from  the  workmen  and  prevent  it  from  entering  the 
air  of  the  room. 

6.  No  bale  of  wool  or  hair  shall  be  stored  in  a  sorting  room ;  nor  any  wool  or 
hair  except  in  a  space  effectually  screened  off  from  the  sorting  room. 

No  wool  or  hair  shall  be  stored  in  a  willowing  room. 

7.  In  each  sorting  room,  and  exclusive  of  any  portion  screened  off,  there  shall 
be  allowed  an  air  space  of  at  least  1.000  cubic  feet  for  each  person  employed 
therein. 

8.  In  each  room  in  which  sorting,  willowing,  or  combing  is  carried  on,  suit- 
able inlets  from  the  open  air  or  other  suitable  source  shall  be  provided  and 
arranged  in  such  a  way  that  no  person  employed  shall  be  exposed  to  a  direct 
draft  from  any  air  inlet  or  to  any  draft  at  a  temperature  of  less  than  50°  F. 

The  temperature  of  the  room  shall  not,  during  working  hours,  fall  below 
50°  F. 

9.  All  bags  in  which  wool  or  hair  of  the  kinds  named  in  the  schedules  has 
been  imported  shall  be  picked  clean  and  not  brushed. 

10.  All  pieces  of  skin,  scab,  and  clippings  or  shearings  shall  be  removed  daily 
from  the  sorting  room  and  shall  be  disinfected  or  destroyed. 

11.  The  dust  carried  by  the  exhaust  draft  from  opening  screens,  sorting 
boards,  willowing  or  other  dust-extracting  machines  and  shafts  shall  be  dis- 
charged into  properly  constructed  receptacles  and  not  into  the  open  air. 

Each  extracting  shaft  and  the  space  beneath  the  sorting  boards  and  opening 
screens  shall  be  cleaned  out  at  least  once  in  every  week. 

The  dust  collected  as  above,  together  with  the  sweepings  from  the  opening, 
sorting,  and  willowing  rooms,  shall  be  removed  at  least  twice  a  week  and 
burned. 

The  occupier  shall  provide  and  maintain  suitable  overalls  and  respirators,  to 
be  worn  by  the  persons  engaged  in  collecting  and  removing  the  dust. 

Such  overalls  shall  not  be  taken  out  of  the  works  or  warehouse,  either  for 
washing,  repairs,  or  any  other  purpose,  unless  they  have  been  steeped  over- 
night in  boiling  water  or  a  disinfectant. 

12.  The  floor  of  every  room  in  which  opening,  sorting,  or  willowing  is  car- 
ried on  shall  be  thoroughly  sprinkled  daily  with  a  disinfectant  solution  after 
Work  has  ceased  for  the  day,  and  shall  be  swept  immediately  after  sprinkling. 

13.  The  walls  and  ceilings  of  every  room  in  which  opening,  sorting,  or  willow- 
ing is  carried  on  shall  be  limewashed  at  least  once  a  year  and  cleansed  at  least 
once  within  every  six  months,  to  date  from  the  time  when  they  were  last 
cleansed. 

14.  The  following  requirements  shall  apply  to  every  room  in  which  unwashed 
wool  or  hair  of  the  kinds  named  in  the  schedules,  after  being  opened  for  sort- 
ing, manufacturing,  or  washing  purposes,  is  handled  or  stored : 

(a)  Sufficient  and  suitable  washing  accommodation  shall  be  provided  out- 
side the  rooms  and  maintained  for  the  use  of  all  persons  employed  in  such 
rooms.  The  washing  conveniences  shall  comprise  soap,  nailbrushes,  towels, 
and  at  least  one  basin  for  every  five  persons  employed  as  above,  each  basin  being 
fitted  with  a  waste  pipe  and  having  a  constant  supply  of  water  laid  on. 

(b)  Suitable  places  shall  be  provided  outside  the  rooms  in  which  persons 
employed  in  such  rooms  can  deposit  food,  and  clothing  put  off  during  working 
hours. 

(c)  No  person  shall  be  allowed  to  prepare  or  partake  of  food  in  any  such 
room.  Suitable  and  sufficient  meal-room  accommodation  shall  be  provided  for 
workers  employed  in  such  rooms. 


ANTHRAX   AS   AN    OCCUPATIONAL   DISEASE APPENDIX   B.        139 

{d)  No  person  having  any  open  cut  or  sore  shall  be  employed  in  any  such 
room. 

The  requirements  in  paragraph  (c)  shall  apply  also  to  every  room  in  which 
any  wool  or  hair  of  the  kinds  named  in  the  schedules  is  carded  or  stored. 

15.  Requisites  for  treating  scratches  and  slight  wounds  shall  be  kept  at  hand. 

16.  The  occupier  shall  allow  any  of  H.  M.  inspectors  of  factories  to  take  at 
any  time,  for  the  purpose  of  examination,  sufficient  samples  of  any  wool  or  hair 
used  on  the  premises. 

DUTIES  OF  PERSONS  EMPLOYED. 

17.  No  bale  of  wool .  or  hair  of  the  kinds  named  In  the  schedules  shall  be 
opened  otherwise  than  as  permitted  by  paragraph  1  of  regulation  1,  and  no 
bale  of  wool  or  hair  of  the  kinds  named  in  schedule  A  shall  be  opened  except 
after  thorough  steeping  in  water. 

If  on  opening  a  bale  any  damaged  wool  or  hair  of  the  kinds  named  in  the 
schedules  is  discovered,  the  person  opening  the  bale  shall  immediately  report 
the  discovery  to  the  foreman. 

18.  No  wool  or  hair  of  the  kinds  named  in  schedule  B  shall  be  opened  other- 
wise than  as  permitted  by  regulation  2. 

19.  No  wool  or  hair  of  the  kinds  named  in  the  schedules  shall  be  sorted  other- 
wise than  as  permitted  by  regulation  4. 

20.  No  wool  or  hair  of  the  kinds  named  in  the  schedules  shall  be  widowed 
except  as  permitted  by  regulation  5. 

21.  Every  person  employed  in  a  room  in  which  unwashed  wool  or  hair  of  the 
kinds  named  in  the  schedules  is  stored  or  handled  shall  observe  the  following 
requirements : 

(a)  He  shall  wash  his  hands  before  partaking  of  food  or  leaving  the  premises. 

(b)  He  shall  not  deposit  in  any  such  room  any  article  of  clothing  put  off 
during  working  hours.  He  shall  wear  suitable  overalls  while  at  work  and  shall 
remove  them  before  partaking  of  food  or  leaving  the  premises. 

(c)  If  he  has  any  open  cut  or  sore,  he  shall  report  the  fact  at  once  to  the 
foreman  and  shall  not  work  in  such  a  room. 

No  person  employed  in  any  such  room  or  in  any  room  in  which  wool  or  hair 
of  the  kinds  named  in  the  schedules  is  either  carded  or  stored  shall  prepare  or 
partake  of  any  food  therein  or  bring  any  food  therein. 

22.  Persons  engaged  in  collecting  or  removing  dust  shall  wear  the  overalls  as 
required  by  regulation  11. 

Such  overalls  shall  not  be  taken  out  of  the  works  or  warehouse,  either  for 
washing,  repairs,  or  any  other  purpose,  unless  they  have  been  steeped  overnight 
in  boiling  water  or  a  disinfectant. 

23.  If  any  fan,  or  any  other  appliance  for  the  carrying  out  of  these  regula- 
tions, is  out  of  order,  any  workman  becoming  aware  of  the  defect  shall  imme- 
diately report  the  fact  to  the  foreman. 

SCHEDULE  A. 

(Wool  or  hair  required  to  be  steeped  in  the  bale  before  being  opened.) 

1.  Van  mohair. 

2.  Persian  locks. 

3.  Persian  or  so-called  Persian  (including  Karadi  and  Bagdad),  if  not  sub- 
jected to  the  process  of  sorting  or  willowing. 


140  BULLETIN"    OF    THE   BUREAU    OF    LABOR   STATISTICS. 

SCHEDULE  B. 

(Wool  or  hair  required  to  be  opened  either  after  steeping  or  over  an  efficient 

opening  screen.) 

Alpaca. 

Pelitan. 

East  Indian  cashmere. 

Russian  camel  hair. 

Pekin  camel  hair. 

Persian  or  so-called  Persian  (includiag  Karadi  and  Bagdad),  if  subjected  to 
the  process  of  sorting  or  willowing. 

SCHEDULE  C. 

(Wool  or  hair  not  needing  to  be  opened  over  an  opening  screen,  but  required 
to  be  sorted  over  a  board  provided  with  downward  draft. ) 

All  mohair  other  than  Van  mohair. 

Note. 

The  danger  against  which  these  regulations  are  directed  is  that  of  anthrax — - 
a  fatal  disease  affecting  certain  animals,  which  may  be  conveyed  from  them 
to  man  by  the  handling  of  wools  or  hairs  from  animals  which  have  died  of 
the  disease.  The  germs  of  the  disease  (anthrax  spores)  are  found  in  the  dust 
attaching  to  the  wool  or  in  the  excrement,  and  in  the  substance  of  the  pieces 
of  skin,  and  may  remain  active  for  years.  In  this  country  and  Australia 
anthrax  is  rare,  consequently  there  is  little  danger  in  handling  wools  from  the 
sheep  of  these  two  countries ;  but  in  China,  Persia,  Turkey,  Russia,  the  East 
Indies,  and  in  many  other  parts  of  the  world,  the  disease  is  common,  and 
infected  fleeces  or  locks  (which  may  not  differ  from  others  in  appearance)  are 
often  shipped  to  Great  Britain.  Hence,  in  handling  foreign  dry  wools  and  hair, 
the  above  regulations  should  be  carefully  observed.  Greasy  wools  are  com- 
paratively free  from  dust,  and  therefore  little  risk  is  incurred  in  handling  them. 
The  disease  is  communicated  to  man  sometimes  by  breathing  or  swallowing  the 
dust  from  these  wools  or  hair,  and  sometimes  by  the  poison  lodging  in  some 
point  where  .the  skin  is  broken,  such  as  a  fresh  scratch  or  cut,  or  a  scratched 
pimple,  or  even  chapped  hands.  This  happens  more  readily  on  the  uncovered 
parts  of  the  body,  the  hand,  arm,  face,  and  most  frequently  of  all,  on  the  neck, 
owing  either  to  infected  wool  rubbing  against  the  bare  skin,  or  to  dust  from 
such  wool  alighting  on  the  raw  surface.  But  a  raw  surface  covered  by  clothing 
is  not  free  from  risk,  for  dust  lodging  upon  the  clothes  may  sooner  or  later  work 
its  way  to  the  skin  beneath.  Infection  may  also  be  brought  about  by  rubbing 
or  scratching  a  pimple  with  hand  or  nail  carrying  the  anthrax  poison.  Use  of 
the  nailbrush,  and  frequent  washing  and  bathing  of  the  whole  body,  especially 
of  the  arms,  neck,  and  head,  will  lessen  the  chance  of  contracting  anthrax. 

The  first  symptom  of  anthrax  is  usually  a  small  inflamed  swelling  like  a 
pimple  or  boil — often  quite  painless — which  extends,  and  in  a  few  days  becomes 
black  at  the  center  and  surrounded  by  other  "  pimples."  The  poison  is  now 
liable  to  be  absorbed  into  the  system,  and  will  cause  risk  of  life,  which  can  be 
avoided  only  by  prompt  and  effective  medical  treatment  in  the  early  stage,  while 
the  poison  is  still  confined  to  the  pimple.  Hence  it  is  of  the  utmost  importance 
that  a  doctor  should  be  at  once  consulted  if  there  is  any  suspicion  of  infection. 


ANTHRAX   AS  AN    OCCUPATIONAL   DISEASE APPENDIX   B.       141 

GREAT  BRITAIN:  REGULATIONS  FOR  THE  PROCESSES  INVOLVING 
THE  USE  OF  HORSEHAIR  FROM  CHINA,  SIBERIA,  OR  RUSSIA, 
IN  EFFECT  APRIL  1,  1908.1 

DEFINITIONS. 

"  Material "  means  tail  or  mane  horsehair  from  China,  Siberia,  or  Russia, 
whether  in  the  raw  state  or  partially  or  wholly  prepared,  notwithstanding  that 
such  preparation  may  have  taken  place  in  some  country  other  than  those  named. 

"  Disinfection  "  means  (a)  exposure  to  steam  at  a  temperature  not  less  than 
212°  F.  for  at  least  half  an  hour  of  material  so  loosened,  spread  out,  or  ex- 
posed as  to  allow  the  steam  to  penetrate  throughout ;  or  ( b )  exposure  of  material 
to  such  disinfectant  under  such  conditions  of  concentration  and  temperature  of 
the  disinfectant,  and  duration  and  manner  of  exposure  of  the  material  to  it,  and 
otherwise,  as  are  certified  to  secure  the  destruction  of  anthrax  spores  in  all 
parts  of  all  horsehair  subjected  to  the  process :  Provided,  That  such  a  certificate 
shall  have  no  force  unless  and  until  (1)  a  copy  of  it  has  been  submitted  to  the 
secretary  of  state,  and  (2)  a  copy  of  it  is  kept  in  the  register  required  under 
regulation  1 :  Provided  further,  That  any  such  certificate  may  at  any  time  be 
disallowed  by  the  secretary  of  state,  either  generally  or  with  regard  to  a  factory 
or  workshop  in  which  anthrax  has  occurred. 

"  Certified  "  means  certified  by  the  director  of  a  bacteriological  laboratory 
recognized  by  a  corporation  in  the  United  Kingdom  having  power  to  grant 
diplomas  registrable  under  the  medical  acts,  1858  to  1905. 

It  shall  be  the  duty  of  the  occupier  to  observe  Part  I  of  these  regulations. 

It  shall  be  the  duty  of  all  persons  employed  to  observe  Part  II  of  these  regu- 
lations. 

PART  I.— DUTIES  OF  EMPLOYERS. 

1.  A  register  shall  be  kept  containing  the  prescribed  particulars 2  of  the 
disinfection  of  all  material. 

2.  Material  which  has  not  undergone  disinfection  shall  not  be  stored  except 
in  a  room  set  aside  for  the  purpose,  in  which  no  other  horsehair  shall  be  placed. 

3.  Material  which  has  not  undergone  disinfection  shall  not  be  opened  from 
the  bale  or  sorted  except  in  a  room  set  aside  for  the  purpose,  in  which  no  other 
horsehair  shall  be  placed ;  nor  shall  any  such  material  be  opened  from  the  bale, 
except  over  or  by  the  side  of  an  efficient  screen,  or  sorted  except  over  an 
efficient  screen. 

For  the  purposes  of  this  regulation  no  screen  ghall  be  deemed  to  be  efficient 
unless  it  is  provided  with  an  exhaust  draft  so  arranged  that  at  every  point 
of  the  screen  within  18  inches  of  the  center  the  velocity  of  the  exhaust  draft 
shall  be  at  least  300  linear  feet  per  minute. 

4.  No  material  shall  be  subjected  to  any  manipulation  other  than  opening  or 
sorting  until  it  has  undergone  disinfection. 

5.  Every  widowing  and  dust-extracting  machine  shall  be  covered  over  and 
provided  with  efficient  exhaust  draft  so  arranged  as  to  carry  the  dust  away 
from  the  worker. 

6.  The  dust  from  the  opening  and  sorting  screens,  and  from  the  willow  or 
other  dust-extracting  machines,  shall  be  discharged  into  furnaces  or  into 
chambers  so  constructed  as  to  intercept  the  dust. 

7.  Each  extracting  shaft  and  the  space  beneath  the  opening  and  sorting 
screen  shall  be  cleaned  out  at  least  once  in  every  week. 


1  Oreat  Britain,  Home  Office.     Factory  and  Workshops  Orders,  London,   1000,   p.  93. 

2  See  appended  schedule,  p.  143. 


142  BULLETIN    OF   THE   BUBEAU    OF    LABOR   STATISTICS. 

8.  All  dust  collected  from  the  opening  and  sorting  screens  shall  be  burned. 

9.  There  shall  be  provided  and  maintained  for  the  use  of  persons  employed 
on  material  which  has  not  undergone  disinfection — 

(a)  Suitable  overalls  and  head  coverings,  which  shall  be  collected  at  the  end 
of  every  day's  work,  and  washed  or  renewed  at  least  once  every  week,  and 
shall  not  be  taken  out  of  the  works  for  any  purpose  whatever  unless  they  have 
previously  been  boiled  for  10  minutes  or  have  undergone  disinfection  after 
last  being  used  ;  and 

(b)  A  suitable  meal  room,  separate  from  any  workroom,  unless  the  works  are 
closed  during  meal  hours ;  and 

(c)  A  suitable  cloakroom  for  clothing  put  off  during  working  hours;  and  a 
suitable  place,  separate  from  the  cloakroom  and  meal  room,  for  the  storage  of 
the  overalls ;  and 

(d)  Requisites  for  treating  scratches  and  slight  wounds. 

10.  There  shall  be  provided  suitable  respirators  for  the  use  of  persons 
employed  in  work  necessitated  by  regulations  6,  7,  and  8.  Each  respirator 
shall  bear  the  distinguishing  mark  of  the  worker  to  whom  it-  is  supplied,  and 
the  filtering  material  shall  be  renewed  after  each  day  on  which  it  is  used. 

11.  There  shall  be  provided  and  maintained  in  a  cleanly  state  and  in  good 
repair  for  the  use  of  all  persons  employed  on  material  which  has  not  undergone 
disinfection,  a  lavatory,  under  cover,  with  a  sufficient  supply  of  clean  towels, 
renewed  daily,  and  of  soap  and  nailbrushes,  and  with  either — 

(a)  A  trough  with  a  smooth  impervious  surface,  fitted  with  a  waste  pipe 
without  plug,  and  of  such  length  as  to  allow  at  least  2  feet  for  every  five  such 
persons,  and  having  a  constant  supply  of  warm  water  from  taps  or  jets  above 
the  trough  at  intervals  of  not  more  than  2  feet ;  or 

(b)  At  least  one  lavatory  basin  for  every  five  such  persons,  fitted  with  a 
waste  pipe  and  plug  or  placed  in  a  trough  having  a  waste  pipe,  and  having 
either  a  constant  supply  of  hot  and  cold  water  or  warm  water  laid  on,  or  (if 
a  constant  supply  of  heated  water  be  not  reasonably  practicable)  a  constant 
supply  of  cold  water  laid  on  and  a  supply  of  hot  water  always  at  hand  when 
required  for  use  by  persons  employed. 

12.  No  person  under  18  years  of  age  shall  be  employed  on  material  which  has 
not  undergone  disinfection. 

13.  No  persons  employed  on  material  which  has  not  undergone  disinfection 
shall  be  allowed — 

(a)  To  work  having  any  open  cut  or  sore;  or 

(&)  To  introduce,  keep,  prepare,  or  partake  of  any  food  or  drink,  or  to- 
bacco, in  any  room  in  which  such  material  is  stored  or  manipulated. 

14.  A  cautionary  notice  as  to  anthrax,  in  the  prescribed  form,  shall  be  kept 
affixed  with  these  regulations. 

PART  II.— DUTIES  OF  PERSONS  EMPLOYED. 

15.  No  person  employed  shall — 

(a)  Open,  sort,  or  willow  or  otherwise  manipulate  any  material  except  in 
accordance  with  the  foregoing  regulations. 

(b)  Introduce,  keep,  prepare,  or  partake  of  any  food  or  drink,  or  tobacco, 
contrary   to   regulation   13    (6). 

16.  Every  person  employed  on  material  which  has  not  undergone  disinfection 
shall— 

(a)  Wear  the  overall  and  head  covering  provided  in  pursuance  of  regula- 
tion 9  (a)  while  at  work,  and  shall  remove  them  before  partaking  of  food  or 


ANTHBAX   AS   AX    OCCUPATIONAL   DISEASE APPENDIX   B.        143 

leaving  the  premises,  and  shall  deposit  in  the  cloakroom  provided  in  pursuance 
of  regulation  9  (c)  all  clothing  put  off  during  working  hours;  and 

(b)  Wash  the  hands  and  clean  the  nails  before  partaking  of  food  or  leaving 
the  premises ;  and 

(c)  Report  any  cut  or  sore  to  the  foreman,  and  until  it  has  been  treated, 
abstain  from  work  on  any  such  material. 

17.  Every  person  employed  shall  wear  the  respirator  provided  in  pursuance 
of  regulation  10  while  engaged  in  work  necessitated  by  regulations  6,  7,  and  8. 

18.  If  the  arrangement  for  disinfection,  or  any  fan,  or  any  other  appliance 
for  the  carrying  out  of  these  regulations,  appears  to  any  workman  to  be  out 
of  order  or  defective,  he  shall  immediately  report  it  to  the  foreman. 

SCHEDULE:  PROCESSES  INVOLVING  THE  USE  OF  HORSEHAIR,  1908. 

By  an  order  dated  March  11,  1908,  the  particulars  to  be  entered  on  the 
register  under  regulation  1  of  the  order  as  to  use  of  horsehair  are  to  be : 

With  regard  to  each  consignment  of  such  horsehair  received  in  the  factory 
or  workshop — 

1.  Weight  of  material. 

2.  Date  of  receipt  on  the  premises. 

3.  Country  of  origin. 

4.  Whether  raw  or  partially  or  wholly  prepared. 

5.  Method  of  disinfection. 

And  in  the  case  of  material  disinfected  on  the  premises — 

6.  Date  of  disinfection. 

And  in  the  case  of  material  disinfected  elsewhere  than  on  the  premises — 

7.  Name  of  person  from  whom  the  material  was  obtained. 

FRANCE:  DECREE  RELATING  TO  SPECIAL  HYGIENIC  MEASURES 
FOR  ESTABLISHMENTS  WHERE  THE  WORKERS  ARE  EXPOSED 
TO  ANTHRAX  INFECTION,  1913. 

1.  In  the  establishments  contemplated  in  section  65  of  Book  II  of  the  Labor 
Code,  where  are  handled  in  the  raw  state  skins,  fur,  horsehair,  hogs'  bristles, 
wool,  horns,  bones,  or  other  animal  products  liable  to  be  infected  with  anthrax, 
the  principals,  directors  or  works  .managers  shall  be  required,  irrespective  of 
the  general  measures  prescribed  by  the  decree  of  July  10,  1913,1  to  adopt  the 
special  measures  of  protection  and  hygiene  mentioned  in  the  following  articles. 

In  regard  to  the  application  of  the  present  decree,  such  product  or  animal 
remains  as  have  not  undergone  the  treatment  mentioned  below  shall  be  consid- 
ered as  in  the  raw  state: 

Horsehair,  hogs'  hair  and  bristles :  Stoving  at  103°  for  one  hour,  or  soaking 
for  two  hours  in  boiling  -water,  or  bleaching. 

Skins :  Tanning. 

Wools :  Industrial  degreasing. 

Bones  and  horns:  Stoving  at  103°  for  one  hour  or  soaking  for  two  hours  in 
boiling  water,  or  treatment  with  powerful  antiseptics. 

All  other  methods  of  disinfection  which  the  minister  of  labor,  after  taking 
the  opinion  of  the  consultative  committee  for  arts  and  manufactures,  shall 
recognize  as  equivalent,  may  also  be  allowed. 


1  For  text  of  this  decree  see  Bulletin  of  the  International  Labor  Office,  Vol.  IX,  1914, 
p.  63. 

42S060— Bull.  205—17 10 


144  BULLETIN   OF    THE   BUREAU    OF    LABOR   STATISTICS. 

2.  A  physician  appointed  by  the  principal  of  the  establishment  shall  carry 
out  the  following  inspections  and  make  the  required  reports ;  his  remuneration 
shall  be  at  the  expense  of  the  establishment. 

As  soon  as  it  shall  come  to  the  knowledge  of  principals,  directors,  or  works 
managers  that  a  workman  is  suffering  either  from  a  form  of  pimple,  cut, 
abrasion,  or  crack  which  has  not  healed  up  after  three  days'  dressing  in  the 
factory,  they  shall  have  him  at  once  examined  by  the  physician,  who  shall 
prescribe  the  necessary  treatment.  The  name  and  age  of  the  worker  and 
the  work  in  which  he  was  engaged,  the  origin  of  the  materials  recognized  as 
liable  to  have  caused  the  infection,  as  also  the  result  of  the  medical  examina- 
tion, shall  be  entered  in  a  special  register. 

Every  establishment  shall  be  provided  with  a  "  first-aid  "  box  containing  the 
remedies  and  materials  for  dressing,  as  prescribed  by  ministerial  order.  This 
box  shall  always  be  kept  in  good  condition,  and  placed  in  an  easily  accessible 
place. 

3.  The  principals  of  works,  directors,  or  managers  shall  be  required  to  pro- 
vide the  workers  with  impermeable  aprons  and  legging  overalls  for  all  work  in 
which  the  body  is  liable  to  come  in  contact  with  the  water  used  in  the  treatment 
of  the  products  of  animal  remains  mentioned  in  section  1. 

4.  The  following  industries  shall  be  considered  as  dangerous  within  the  mean- 
ing of  section  5  hereunder,  where  materials  are  treated  which  have  come  from 
districts  indicated  in  an  order  of  the  minister  of  labor,  after  consultation  with 
the  minister  of  commerce  and  industry  and  the  minister  of  agriculture. 

(1)  The  preparation  of  horsehair. 

(2)  The  plucking,  washing,  and  sorting  of  wools. 

(3)  Tawing,  tanning,  and  furriery. 

(4)  The  sorting  and  working  up  of  bones  and  horns. 

The  following  operations  shall  also  be  regarded  as  dangerous  within  the 
meaning  of  the  same  section :  The  unpacking,  manipulation,  and  other  opera- 
tions performed  in  a  dry  condition,  before  disinfection  of  the  materials  enu- 
merated in  section  1,  which  have  come  from  the  regions  indicated  in  the  order 
above  referred  to. 

5.  In  those  parts  of  the  establishment  specially  devoted  to  the  carrying  on 
of  the  industries  or  to  the  performance  of  the  dangerous  operations  defined 
under  section  4,  the  following  precautions  shall  be  observed : 

In  the  workrooms  the  flooring  shall  consist  of  an  impermeable  covering  or 
of  a  sectional  paving  which  can  be  easily  washed.  The  walls  shall  have  a 
coating  which  can  be  thoroughly  washed,  or  shall  be  limewashed. 

This  limewash  coating  shall  be  renewed  whenever  necessary,  and  especially 
when  a  case  of  anthrax  has  occurred.  The  tables,  benches,  and  seats,  also  the 
floors  and  walls,  shall  be  washed  as  often  as  may  be  necessary  with  a  disinfect- . 
ing  solution.    The  tools  shall  be  subjected  to  frequent  disinfection. 

In  the  storehouses  where  the  materials  referred  to  in  section  1  are  kept, 
every  space  temporarily  unoccupied  shall  be  cleaned  with  a  disinfectant. 

In  the  case  of  wool,  horsehair,  hogs'  hair  and  bristles,  the  handling  shall 
be  done  wherever  possible  in  closed  vessels. 

As  regards  the  material  referred  to  in  the  preceding  paragraph,  the  operations 
which  it  is  impossible  to  carry  out  in  a  closed  vessel — such  as  the  opening  of 
bales  and,  if  necessary,  the  beating — must  be  carried  out  under  such  conditions 
as  will  allow  of  the  collection  of  all  the  offal  and  its  subsequent  destruction. 

The  dressing  and  washing  rooms  for  the  use  of  the  workers  shall  be  fitted  up 
outside  the  places  where  dangerous  operations  are  carried  on. 


ANTHRAX  AS  AN   OCCUPATIONAL   DISEASE APPENDIX   B.       145 

The  said  dressing  and  washing  rooms  shall  he  fitted  with  a  sufficient  num- 
ber of  basins  or  taps,  with  an  ample  provision  of  water  and  soap  and  a  towel 
for  each  worker,  which  latter  shall  be  renewed  at  least  once  a  week.  They 
shall,  moreover,  be  provided  with  wardrobes  or  boxes  which  can  be  closed  by 
key  or  a  padlock,  and  which  are  divided  into  two  compartments,  so  that  the 
outdoor  clothes  may  be  kept  separate  from  the  working  clothes. 

In  default  of  a  separate  cupboard  divided  into  two  compartments,  every 
worker  shall  have  at  his  disposal  two  clothes  pegs  on  opposite  sides  of  the 
dressing  room,  for  the  purpose  of  receiving  on  one  side  his  ordinary  and  on 
the  other  side  his  working  clothes.  The  clothes  pegs  shall  be  separated  by  a 
space  of  at  least  30  centimeters  [11-8  inches]. 

The  workers  shall  be  provided  with  overalls  for  handling  materials  in  the 
raw  state.  They  shall  also  be  provided  with  protections  for  the  neck,  for  the 
transport  of  those  materials  which  have  to  be  carried  on  the  shoulder.  Un« 
less  impracticable,  all  raw  materials  shall  be  carried  in  carts  or  handbarrows. 

6.  The  minister  of  labor,  by  order  issued  on  the  report  of  the  industrial  in- 
spectors, and  after  consultation  with  the  consultative  committee  of  arts  and 
manufactures,  shall  have  power  to  grant  to  an  establishment,  for  a  fixed  term, 
relief  from  the  whole  or  a  portion  of  the  provisions  of  section  5  (paragraphs 
5  and  6)  if  it  is  recognized  that  the  application  of  these  provisions  is  practically 
impossible,  and  that  the  health  of  the  workers  is  insured  under  conditions  at 
least  equal  to  those  which  are  fixed  by  the  present  decree. 

7.  The  principals,  directors,  or  works  managers  shall  be  required  to  affix 
in  a  conspicuous  position  of  the  working  premises — 

(1)  The  text  of  the  present  decree. 

(2)  Shop  rules,  imposing  on  the  workers  the  following  duties:  That  they 
shall  use  the  various  working  clothes  and  other  working  articles  placed  gratui- 
tously at  their  disposal ;  that  they  shall  make  use  of  the  dressing  room  and  the 
washstands  referred  to  in  section  5  (paragraphs  7,  8,  and  9)  ;  make  good  use 
of  the  provisions  for  cleanliness  whenever  leaving  the  premises ;  and  bring  no 
food  into  the  workroom. 

(3)  A  notice  pointing  out  the  dangers  of  anthrax,  as  also  the  precautions  to 
be  taken  to  avoid  them,  and  the  necessity  of  the  workers  to  make  the  declara- 
tion indicated  in  section  2. 

(4)  The  name  and  address  of  the  physician  intrusted  with  the  medical  serv- 
ice of  the  establishment. 

The  terms  of  the  notice  mentioned  in  the  present  section  under  (2)  shall  be 
fixed  by  a  ministerial  order. 

GERMANY:  ORDER  CONCERNING  THE  EQUIPMENT  AND  OPERA- 
TION OF  HORSEHAIR  SPINNING  ESTABLISHMENTS,  OF  SHOPS 
WHERE  OTHER  ANIMAL  HAIR  AND  BRISTLES  ARE  MANIPU- 
LATED, AND  OF  BRUSH  FACTORIES,  1902. 

GENERAL   RULES. 

1.  The  following  rules  apply  to  all  establishments  where  horse,  cattle,  and 
goat  hair  and  bristles  or  hair  of  hogs  are  manipulated  or  spun  into  curled  hair, 
as  well  as  to  brush  factories. 

2.  Imported  animal  hair  and  bristles  must  not  be  manipulated  unless  disin- 
fected in  the  establishment  where  they  are  to  be  used. 

Disinfection  must  be  effected  by  one  of  the  following  methods : 
(1)  Exposing  the  materials  for  at  least  half  an  hour  to  a  current  of  steam 
under  a  pressure  of  0.15  over  atmospheric  pressure. 


146  BULLETIN    OF    THE   BUREAU    OF    LABOR   STATISTICS. 

(2)  Boiling  the  materials  for  at  least  a  quarter  of  an  hour  in  a  2  per  cent 
solution  of  permanganate  of  potassium  and  then  bleaching  them  in  a  3  or  4 
per  cent  solution  of  sulphurous  acid. 

(3)  Boiling  them  for  at  least  two  hours  in  water. 

Other  processes  of  disinfection  may  be  authorized  by  the  imperial  chancellor. 

The  higher  administrative  authorities  may  order  that  the  disinfection  pro- 
vided in  section  2,  No.  1,  be  effected  in  a  public  disinfecting  establishment  if 
there  is  one  in  the  place  where  the  factory  is  situated  or  in  its  immediate 
vicinity. 

3.  The  manufacturer  may  be  permitted  to  dispense  with  disinfection  if  he 
can  prove,  in  conformity  with  regulations  to  be  issued  by  the  central  State 
authorities,  that  the  materials  had  already  been  disinfected  according  to  the 
above  rules  when  he  received  them  and  that  he  has  stored  them  separately 
from  nondisinfected  material. 

The  manufacturer  may  omit  disinfection  of  white  bristles  provided  that  he 
bleaches  them  before  they  are  being  worked  up  or  if  he  has  received  them 
bleached  (so-called  French  dressed  bristles)  and  stored  them  separately  from 
other  nondisinfected  material. 

4.  The  central  administrative  authorities  may  authorize  exemptions  from  the 
rules  in  section  2  for  materials  which — 

(1)  According  to  previous  experience  can  not  be  subjected  to  the  disinfec- 
tion prescribed  in  section  2  without  being  exposed  to  considerable  injury. 

(2)  Are  proved  to  have  been  subjected  abroad  to  treatment  which  is  con- 
sidered equivalent  to  disinfection  in  conformity  with  the  rules  in  force  in  the 
German  Empire. 

The  central  administrative  authorities  must  keep  a  register  of  the  cases  and 
reasons  for  which  exemptions  are  granted.  It  must  also  indicate  in  the  cases 
mentioned  in  paragraph  (2)  of  this  section  the  kind  of  treatment  to  which  the 
materials  have  been  subjected  abroad.  A  copy  of  this  register  must  be  sub- 
mitted annually,  not  later  than  February  1,  to  the  central  authority  of  the 
State. 

5.  The  materials  for  which  disinfection  is  required  must,  before  disinfection, 
be  subjected  only  to  operations  required  to  ascertain  their  condition,  to  pre- 
vent them  from  deteriorating,  or  to  prepare  them  for  disinfection,  such  as 
unpacking,  cutting  the  hair  adhering  to  the  tails,  transporting  to  the  disin- 
fecting apparatus,  tying  of  the  bristles  in  bundles,  etc.  Sorting  is  allowed  only 
so  far  as  it  is  necessary  for  the  separation  of  hair  which  has  to  be  subjected  to 
different  processes  of  disinfection. 

6.  Juvenile  workers  must  not  be  employed  either  in  disinfecting  processes, 
or  on  materials  exempted  from  disinfection  in  conformity  with  section  4,  para- 
graph (1),  nor  are  they  allowed  to  work  in  the  processes  specified  in  section  5. 

7.  The  employer  must  see  that  workers  who  have  skin  sores,  especially  on 
the  neck,  face,  and  hands,  are  not  employed  in  the  processes  specified  in  section  6. 

8.  The  employer  must  keep  a  register  in  which  he  must  enter  the  stock  of 
hair  and  bristles  received  by  him  in  such  a  way  that  the  quantity  of  these  mate- 
rials, the  seller  and,  if  possible,  also  the  place  of  origin,  the  time  at  which  they 
were  disinfected  and  the  processes  used,  or  the  reason  for  which  disinfection 
was  omitted  become  evident. 

If  the  disinfection  took  place  in  a  public  establishment,  the  certificates  given 
on  that  occasion  must  be  collected,  preserved,  and  produced  whenever  required 
by  the  supervisory  officers. 

9.  Supplies  of  nondisinfected  materials  which  are  subject  to  disinfection 
and  those  which  are  exempt  from  disinfection  according  to  section  4,  para- 


ANTHRAX   AS  AN    OCCUPATIONAL   DISEASE APPENDIX   B.        147 

graph  (1),  must  be  kept  in  special  locked  rooms  and  may  be  taken  to  these 
rooms  or  removed  from  them  only  by  passages  and  staircases  which  are  not 
used  by  workers  occupied  on  disinfected  or  on  domestic  materials.  Disin- 
fected or  domestic  goods  must  not  be  transported  through  those  passages 
and  staircases. 

The  operations  which  must  necessarily  precede  disinfection,  disinfection 
itself,  and  the  manipulation  of  materials  exempted  from  disinfection  in  ac- 
cordance with  section  4,  paragraph  (1),  must  not  take  place  in  rooms  where 
disinfected  or  domestic  materials  are  kept  or  manipulated. 

The  places  where  disinfected  materials  or  those  exempted  from  disinfection 
according  to  section  4,  paragraph  (1),  are  kept  or  manipulated,  the  entrance 
ways  to  those  rooms,  also  the  passages  and  staircases  through  which  the  mate- 
rials of  this  category  are  transported,  must  be  kept  constantly  clean.  In  clean- 
ing them  care  must  be  taken  to  make  as  little  dust  as  possible.  The  sweepings 
from,  and  the  wrappings  in  which  the  nondisinfected  materials  arrived,  must 
be  burned  or  disinfected  (section  2,  paragraph  2).  These  measures  apply  equally 
to  dust  generated  by,  and  refuse  resulting  from,  the  wrorking  up  of  nondisin- 
fected materials  and  to  rubbish. 

REGULATIONS  FOR  LARGE  ESTABLISHMENTS. 

10.  In  establishments  regularly  employing  10  or  more  workers,  the  floor  of 
the  workshop  must  be  solid  and  tight  and  must  allow  an  easy  removal  of  dust 
by  washing.     Wooden  floors  must  be  smoothly  planed  and  water-tight. 

The  walls  and  ceilings,  unless  they  are  covered  with  a  hard  glazed  surface 
which  allows  washing  or  are  oil  painted,  must  be  whitewashed  at  least  once  a 
year. 

In  the  construction  of  new  and  the  enlargement  of  existing  establishments, 
measures  must  be  taken  that  in  new  workrooms  where  operations  generating 
considerable  dust  are  to  be  carried  out,  the  number  of  workers  should  be  so 
calculated  that  each  will  have  at  least  15  cubic  meters  [530  cubic  feet]  air 
space. 

11.  Workrooms  must  be  completely  aired  for  at  least  half  an  hour  twice  a 
day,  i.  e.,  during  the  noon  hour  and  after  the  close  or  before  the  beginning  of 
work.    During  this  time  workers  must  not  be  allowed  in  the  shops. 

The  floors  of  rooms  where  work  generating  dust  is  carried  on  must  be  cleaned 
at  least  once  a  day  by  washing.  The  work  tables  in  these  rooms  must  be  washed 
at  least  twice  a  week. 

12.  In  establishments  where  horsehair  is  spun  or  otherwise  prepared  the 
sorting  and  hackling  must  be  done  in  special  rooms  separated  from  the  others. 
The  dust  generated  and  the  rubbish  must  be  gathered  and  removed. 

13.  Mixing,  cleaning,  and  hackling  machines  (beating  and  willowing  ma- 
chines) must  be  covered  and  provided  with  effective  exhaust  drafts.  The  dust 
must  be  collected  in  a  special  chamber,  and  if  it  comes  from  nondisinfected 
materials  it  must  be  burned. 

14.  The  workers  employed  on  the  processes  preliminary  to  disinfection  or  in 
disinfection  itself  or  in  the  treatment  of  materials  exempted  from  disinfection 
according  to  section  4,  paragraph  (1),  must  be  provided  at  the  employer's 
expense  with  working  clothes  and  caps  in  sufficient  number  and  of  proper 
materials. 

By  issuing  suitable  regulations  and  providing  supervision  the  employer  must 
see  to  it  that  the  work  clothes  are  used  only  by  those  workers  to  whom  they 
are  assigned,  and  that  during  the  time  when  they  are  not  in  use  the  work 
clothes  are  kept  in  places  designated  for  that  purpose  and  disinfected  at  least 


148  BULLETIN"   OF    THE   BUREAU    OF   LABOR   STATISTICS. 

once  a  week.  The  employer  must  give  to  the  workers  mentioned  in  the  first 
paragraph  of  this  section  the  opportunity  of  taking  a  warm  bath  at  least  twice 
a  week. 

15.  In  a  part  of  the  establishment,  free  from  dust,  a  dressing  and  washing 
room  shall  be  kept  for  the  workers ;  also  a  lunch  room  if  necessary.  The  lunch 
room  must  be  separated  from  the  dressing  room.  These  rooms  must  be  kept 
clean  and  free  from  dust,  and  during  the  cold  season  they  must  be  heated.  In 
the  lavatory  the  workers  must  be  supplied  with  a  sufficient  quantity  of  water, 
soap,  and  towels,  and  with  an  adequate  number  of  places  for  keeping  the  clothes 
which  are  taken  off  before  beginning  work. 

16.  The  employer  must  issue  for  the  workers  manipulating  the  materials 
mentioned  in  the  first  paragraph  of  section  2  the  following  rules : 

(1)  The  workers  must  use  the  working  clothes  provided  for  them  during 
those  operations  for  which  these  clothes  are  assigned. 

(2)  The  workers  must  not  bring  any  food  into  the  workshops.  They  must 
eat  only  outside  of  these  places. 

(3)  The  workers  are  not  allowed  to  enter  the  lunch  rooms,  to  eat,  or  leave 
the  establishment,  except  after  taking  off  the  working  clothes  prescribed  in  the 
first  paragraph  of  section  14  and  carefully  washing  their  faces,  necks,  hands, 
and  eyes. 

In  rules  which  are  issued  it  must  be  stipulated  that  workers  who  violate  the 
above  regulations  in  spite  of  repeated  warnings  will  be  discharged  without 
notice  before  the  expiration  of  their  time. 

If  shop  rules  are  issued  for  an  establishment,  the  above  regulations  must  be 
included. 

17.  Sections  1-16,  legibly  written  or  printed,  must  be  posted  in  each  work- 
shop, dressing  room,  and  lunch  room. 

PRUSSIA:  ORDER  RELATING  TO  THE  PROPAGATION  OF  ANTHRAX 
THROUGH  ANIMAL  SKINS,  1902. 

INSTRUCTIONS   WITH  REGARD  TO  THE  DANGERS  TO  HEALTH  INVOLVED  IN  THE 
MANIPULATION  OF  RAW  FOREIGN  SKINS. 

Experience  has  shown  that  the  traffic  in  raw  skins  and  hides,  especially 
those  of  foreign  origin,  involves  danger  to  the  health  of  human  beings  and 
animals.  Researches  have  proved  that  some  of  the  raw  skins  (especially  deer 
and  kipskins  coming  from  America,  East  India,  and  China)  were  taken  from 
anthrax-infected  animals.  The  cause  of  the  disease  is  contained  in  these  skins 
and  hides  in  the  form  of  very  resistant  anthrax  spores.  The  usual  processes 
to  which  the  skins  are  subjected,  such  as  drying,  or  treatment  with  salt,  salt- 
peter, or  arsenic,  do  not  destroy  the  spore.  The  dust  which  is  generated  during 
sorting,  packing,  and  transportation,  and  also  during  the  opening  of  the  bales 
and  becomes  mixed  with  shed  hair  is  the  principal  carrier  of  the  disease.  The 
particles  of  dust  and  the  hair,  to  which  the  anthrax  spores  adhere,  are  deposited 
on  the  clothes  and  bodies  of  persons  near  by,  and  enter  the  mouth,  nose,  ears, 
etc.  Even  the  smallest  abrasion  of  the  skin  may  be  instrumental  in  producing 
infection.  Danger  lies  in  the  manipulation  of  raw  materials  and  in  the  evil 
habit  of  removing  with  the  finger  nails  dry  crusts  on  the  skins.  The  persons 
employed  on  raw  skins  can  carry  infection  to  other  places  on  their  soiled 
clothes,  hair,  hands,  etc. 

It  has  also  shown  that  anthrax  may  be  produced  by  the  pollution  of  fodder 
and  straw  with  particles  of  dust  and  hair  from  imported  raw  skins  by  the 
use  of  tanbark  refuse  as  bedding  in  stalls  and  passageways,  and  by  the  tending 


ANTHRAX  AS  AN"   OCCUPATIONAL   DISEASE APPENDIX   B.        149 

of  animals  by  persons  handling  raw  foreign  hides.  Even  the  use  of  refuse 
from  tanneries  for  the  purpose  of  fertilizing  pastures  and  fields,  also  the  soaking 
of  skins  in  rivers  and  similar  waters,  may  lead  to  the  propagation  of  anthrax. 
A  reliable  and  practical  process  of  disinfection  which  does  not  injure  the 
skins  is  not  known.  For  the  purpose  of  minimizing  the  danger  of  infection  the 
following  precautionary  measures  can  be  recommended,  especially  to  persona 
regularly  engaged  in  the  handling  of  raw  skins : 

(1)  Storage  places  for  raw  foreign  hides  should  be  situated  in  out  of  the 
way  localities  at  considerable  distance  from  dwellings  and  from  stables.  They 
must  be  carefully  fenced  so  that  animals  can  not  enter  them. 

(2)  Sheds,  etc.,  for  the  storage  of  straw  and  fodder  must  not  be  used  as 
storage  places  or  workrooms  for  the  preparation  of  raw  hides. 

(3)  The  generation  of  dust  must  be  avoided  as  much  as  possible  during  the 
opening  of  the  bales,  also  during  sorting,  piling,  packing,  and  other  manipula- 
tions of  skins ;  when  necessary  the  skins  should  be  sprinkled  with  water. 

(4)  The  places  where  raw  foreign  hides  are  stored  or  worked  up  must  be 
carefully  cleaned  after  they  are  used ;  they  must  be  disinfected  at  proper 
intervals. 

(5)  Tanbark  used  in  the  tanning,  the  hair  and  other  refuse  from  the  tan- 
neries, and  other  remains,  the  straw,  rags,  cords,  etc.,  which  were  used  in  pack- 
ing the  raw  foreign  hides,  as  well  as  the  sweepings,  must  be  either  burned  or 
buried  after  disinfection. 

(6)  Persons  having  external  wounds  should  not  be  allowed  to  manipulate 
raw  foreign  hides. 

(7)  Before  leaving  the  work  place  persons  occupied  in  handling  raw  foreign 
hides  must  carefully  clean  their  faces,  arms,  hands,  hair,  and  beard. 

(8)  The  storerooms,  work  places,  etc.,  must  be  cleaned  only  by  wet  processes. 

(9)  A  solution  of  chloride  of  lime  (one  part  chloride  of  lime  and  three  parts 
water)  or  a  mixture  of  sulphuric  and  carbolic  acid  (one  part  of  sulphuric  acid, 
two  parts  of  crude  carbolic  acid,  and  four  parts  of  water)  are  recommended  as 
disinfectants.  These  disinfectants  should  be  also  used  on  sweepings  and  other 
refuse. 

PRUSSIA:    REGULATIONS    FOR    THE    PROTECTION    OF    WORKERS 
AGAINST  THE  DANGERS  OF  ANTHRAX,  1910. 

1.  Raw  sheep  and  goat  skins,  as  well  as  dry  imported  raw  skins,  shall  be 
stored  in  separate  storerooms,  capable  of  being  locked,  which  are  used  for  this 
purpose  only,  and  are  not  in  direct  communication  with  living  rooms,  stables  or 
rooms  for  storing  fodder. 

2.  The  storerooms  shall  be  provided  with  floors  made  of  cement,  asphalt  or 
other  impervious  material,  the  joints  being  perfectly  tight.  Premises  which 
have  already  been  in  existence  may  be  used  for  a  further  period  not  exceeding 
10  years,  should  they  be  provided  with  floors  of  the  nature  referred  to  above. 

The  storerooms  shall  be  cleaned  at  least  once  a  week,  by  means  of  damp 
sawdust  or  damp  tanbark,  for  instance.  Storerooms  shall  be  disinfected  after 
they  have  been  wholly  or  partially  emptied,  by  washing  them  with  a  solution  of 
1  part  fresh  chloride  of  lime  in  20  parts  water,  in  conformity  with  the  regula- 
tion that  the  whole  of  the  storeroom  shall  be  disinfected  in  this  manner  at  least 
once  a  year,  but  walls  and  ceiling  only  in  so  far  as  they  have  come  in  contact 
with  raw  skins.  The  said  whitewash  shall  not  be  removed  for  a  space  of  24 
hours  at  least. 


150  BULLETIN    OF   THE   BUREAU    OF   LABOR   STATISTICS. 

Refuse  and  valueless  packing  material  (straw,  bast,  ropes,  etc.)  shall  be 
burned. 

3.  Raw  sheep  and  goat  skins,  as  well  as  dried  imported  raw  skins,  shall  be 
handled  with  special  care.  Above  all,  care  must  be  taken  not  to  subject  the  said 
skins  to  an  unnecessary  amount  of  shaking  and  not  to  throw  them  about. 

For  the  transport  of  skins  the  use  of  special  contrivances,  such  as  wagons 
(trolleys),  etc.,  is  very  strongly  recommended. 

Workers  shall  not  be  allowed  to  carry  skins  unless  they  have  been  provided 
with  protective  hoods,  which  cover  the  head,  neck,  and  shoulders ;  while  they 
must  also  be  provided  with  a  sufficient  number  of  smocks  of  good  quality  when 
handling  dried  foreign  skins. 

The  employer  shall  insure  that,  by  means  of  suitable  arrangements  and 
proper  supervision,  smocks  and  protective  hoods  are  worn  only  by  those  workers 
to  whom  they  have  been  handed  for  use,  and  that  they  are  disinfected  at  once 
after  having  been  in  use  for  one  week.  The  said  disinfection  shall  be  effected 
as  the  employer  may  direct,  either  by  steaming  at  a  pressure  of  not  less  than 
0.15  above  atmospheric  pressure,  or  by  boiling  for  at  least  one  hour. 

4.  Workers  who  come  in  contact  with  raw  sheep  or  goat  skins  or  dried  im- 
ported raw  skins  shall  have  their  attention  drawn  at  the  commencement  of 
their  employment  to  the  dangers  of  anthrax,  to  which  they  may  be  exposed,  and 
they  shall  be  handed  a  copy  of  the  regulations  for  the  prevention  of  accidents, 
and  likewise  instructions  in  regard  to  anthrax.  The  said  instructions  shall 
further  be  posted  up  in  the  workrooms.  The  necessary  number  of  copies  of  the 
same  will  be  placed  at  the  disposal  of  the  employers  by  the  association. 

5.  A  part  of  the  works,  as  far  as  possible  free  from  dust  and  suitable  for  the 
purpose,  shall  be  reserved  for  washing  rooms  and,  where  it  is  customary  for 
workers  to  take  their  meals  within  the  works,  lunch  rooms  shall  be  provided. 
The  said  lunch  rooms  shall  be  kept  clean  and  free  from  dust,  and  shall  be 
heated  during  the  cold  season. 

6.  The  employer  shall  also  insure  that  any  worker  who  exhibits  symptoms 
of  anthrax  shall  immediately  place  himself  under  medical  treatment,  and,  fur- 
ther, that  any  workers  suffering  from  anthrax  shall  be  admitted  to  the  hospital 
indicated  by  the  trade  association. 

7.  Workers  who  are  engaged  in  working  up  raw  sheep  and  goat  skins,  as  also 
dried  imported  raw  skins,  shall  not  be  allowed  to  enter  the  lunch  room,  to  take 
any  meals,  or  to  leave  the  works,  until  they  have  divested  themselves  of  their 
working  clothes  and  have  thoroughly  washed  the  face,  head,  hair  and  beard, 
neck,  hands,  and  arms. 

The  workers  shall  not  be  permitted  to  take  beverages  in  open  containers  or 
foodstuffs  into  the  workroom.  They  shall  likewise  be  forbidden  to  take  meals 
in  the  latter. 

8.  Should  the  worker  become  aware  of  an  itching  or  burning  sensation  on  the 
head,  or  pain  arising  from  a  darkish  pimple,  which,  although  at  first  of  small 
size,  rapidly  grows  larger,  he  shall  immediately  inform  the  works  management 
and  place  himself  under  medical  treatment  or  enter  the  hospital  to  which  he 
has  been  referred,  since  delay  is  dangerous  and  would  probably  lead  to  the 
death  of  the  worker. 


INDEX. 


A. 

Age.     (See  Nativity,  age,  sex,  and  conjugal  condition  of  fatal  cases,  etc.)  Page. 

Agriculture  and  other  industries  involving  direct  contact  with  animals 19 

Agriculture,  Department  of,  and  Department  of  Treasury,  joint  order  No.  1 120-130 

Agriculture,  prevention  of  anthrax  in,  legislation  in  regard  to,  United  States 82,  83 

Animal  products  liable  to  be  infected  with  anthrax,  imports  of,  1910  to  1915 84 

Animal  skins,  propagation  of  anthrax  through,  text  of  order  relating  to,  Prussia, 

1902  148, 149 

Animals  subject  to  anthrax,  and  countries  where  the  disease  is  prevalent 12 

Anthrax,   cases  of  : 

Bradford  (England)  and  District  Anthrax  Investigation  Board,  1906  to  1914_  101 

France,  1910  to  1912 104 

Germany,  Imperial  Health  Office,  1910  to  1912 103,  104 

Great  Britain,  chief  factory  inspector,  by  industries,  1900  to  1913 100 

Great  Britain,   workmen's  compensatiop  act,  cases  compensated  under,    1908 

to  1914 113 

Holland,  1898  to  1911 104 

Italy,   1890   to   1904 105 

Massachusetts  hospital,  by  occupations,  June  27,  1881,  to  April  26,  1916 43 

Massachusetts  workmen's  compensation  law,  claims  filed  under 89 

New  York  State  Department  of  Labor,  under  occupational  disease  reporting 

law,  September,  1911,  to  March,  1916 . 37 

Philadelphia  hospital,  duration  of  illness  among  32  cases  in  a 41 

Philadelphia  hospital,  January  1,  1909,  to  April  30,  1916 39 

Russia 106 

Tanning  and   leather   manufacturing   establishments    (19) 44,45 

United  States  registration  area,  1910  to  1915 55-59 

Anthrax  in  Europe   (Chapter  V) 95-114 

Anthrax  in  United  States   (Chapter  IV) 25-93 

B. 

Bacillus  of  anthrax  and  its  spore,  discovery,  characteristics,  etc.,  of 6,  10-12 

Belgium,  wool,  hair,  and  bristles  industry,  protective  legislation  in 110 

Bichloride    of   mercury   solution,   disinfection    of   hides   by,    Treasury    Department 

requirements  as  to '- 85-88,  126,  127 

Boiling.     (See  Disinfection.) 

Bones,  hoofs,  and  horns,  disinfection  of,  joint  order  No.  1 128 

Bradford   (England)  and  District  Anthrax  Investigation  Board 95.96 

Bradford   (England)   and  District  Anthrax  Investigation  Board,  cases  in  wool  in- 
dustry reported  by,  1906  to  1914 ._       101 

Bristles,  imports  of,  into  the  United  States,  1910  to  1915 84 

C. 

China  or  West  Coast  of  India,   hides  and  skins   imported   from,   text   of   regula- 
tions governing,  Great  Britain,  1901 136 

China,  Siberia,  or  Russia,  horsehair  from,  processes  involving  use  of,  text  of  regu- 
lations governing,  Great  Britain,  190S 141-143 

Compensation  for  anthrax  as  an  industrial  injury,  Europe 112-114 

Compensation  for  victims  of  occupational  anthrax,  legislation  as  to.  United  States-  89-93 

Conditions  of  soil  and  temperature  favorable  to  the  development  of  anthrax 13 

Conjugal    condition.      (See   Nativity,    age,    sex,    and    conjugal    condition    of    fatal 
cases,  etc.) 

D. 

Deaths,  recorded  causes  of,  in   fatal   cases,  registration   area,  United   States,  1910 

to  1915 : 55-59 

151 


152  INDEX. 

Deaths.      (See  also  Fatal  cases,  etc.)  Page. 

Delaware,  morocco-leather  center,  experience  in 1 32-35 

Delaware,  quarantine  placards  and  notice  to  employees  in 34 

Devoto,  Prof.  L.,  and  F.  Massarelli,  recommendations  by,  for  control  and  preven- 
tion of  anthrax 123,  124 

Diagnosis,  early,  importance  and  difficulties  of,  etc 26-28 

Disinfection  : 

Bichloride  of  mercury  solution,  Treasury  Department  requirements 85-88,  126,  127 

Boiling,  general  rules,  Germany,  1902 145,  146 

Boiling,  in  water  ;  in  permanganate  of  potassium  solution 115 

Formaldehyde  as  a  germicide  for  wool,  report  of  Bradford  (England)  and  Dis- 
trict Anthrax  Investigation  Board 115, 116 

France,  special  hygienic  measures,  text  of  decree  relating  to,  1913 143—145 

Germany,  horsehair-spinning  establishments,  text  of  order  concerning,  1902_   145—148 

Great  Britain,  general  regulations,  text  of,  1905,  1908 137-143 

Massachusetts,  suggested  rules  and  regulations 132,  133 

Potassium,  permanganate  of,  boiling  in  solution   of 115 

Problem    of,    present    status    of    (Chapter    VI) 115-120 

Prussia,  text  of  regulations,  1902,  1910 148-150 

Schattenfroh  method  of,  for  hides  and  skins 118-120, 132 

Seymour-Jones  method  of,  for  hides  and  skins 118,  119,  132 

Steam  sterilization,  effect  of,  on  wool 116 

United  States,  joint  order  No.  1,  Departments  of  Treasury  and  Agriculture 126—130 

Duration  of  illness  in  32  cases  of  anthrax,  Philadelphia  hospital 41 

E. 

England,  wool,  hair,  and  bristles  industry,  protective  legislation  in 107, 108 

England.     (See  also  Great  Britain.) 

Europe,  anthrax  in   (Chapter  V) 95—114 


Factory  inspector,  chief,  anthrax  cases  reported  to,  Great  Britain,  1900  to  1913 100 

Fatal  cases,  place  and  date  of,  in  registration  area,  United  States,  1910  to  1915 54—59 

Fatal    cases    reported    in    registration    area,    United    States,    1910    to    1915.    his- 
tories,   etc 46-78 

Fatal  cases  to  total  number  of  cases,  probable  ratio  of,  United  States 78-80 

Formaldehyde  as  a  germicide  for  wool,  report  of  Bradford  (England)  and  District 

Anthrax  Investigation  Board 115, 116 

France : 

Cases  reported,  1910  to  1912 104 

Establishments  where  workers  are  exposed  to  anthrax  infection,  text  of  decree 

affecting,    1913 143-145 

Manufacturers'    Association    for    Prevention    of    Industrial    Accidents,    activ- 
ity of  -1 97 

Wool,  hair,  and  bristles  industry,  protective  legislation 109, 110 

G. 

Germany  : 

Compulsory  reporting  laws  and  resultant  data 102-104 

Employers'  Mutual  Trade  Association,  activity  of 96,  97 

Horsehair-spinning    establishments,    and    hair,    bristles,    and    brush    factories, 

equipment  and  operation  of,  text  of  order  governing,  1902 145—148 

Imperial  Health  Office,  anthrax  cases  reported  to,  1910  to  1912 103,  104 

Wool,  hair,  and  bristles  industry,  protective  legislation 108, 109 

Germany.     (See  also  Prussia.) 

Glue  stock,  certification  and  disinfection,  joint  order  No.  1 127,  128 

Governmental   investigations,   Europe 98,  99 

Great  Britain  : 

Compulsory  reporting  laws  and  resultant  data 99-102 

Factory  inspector,  chief,  anthrax  cases  reported  to,  1900  to  1913 100 

Hides  and  skins  imported  from  China  or  West  Coast  of  India,  text  of  regu- 
lations governing,   1901 136 

Horsehair    from    China,    Siberia,    or    Russia,    text    of    regulations    governing 

use    of,    1908 141-143 


INDEX.  153 

Great  Britain — Continued.  Page. 

Wool,  goat  hair,  and  camel  hair,  sorting,  washing,  etc.,  of,  text  of  regulations 

governing,    1905 137-140 

Workmen's    compensation    act,    anthrax    cases    compensated    under,    1908    to 

1914 113 

Great  Britain.     (See  also  England.) 

H. 

Hair,  bristle,  and  brush  factories,  text  of  order  concerning  equipment  and  oper- 
ation of,  Germany,  1902 145-148 

Hair,   bristles,   and   pigs'    wool,    disinfection    of,    suggested   rules   and    regulations, 

Massachusetts,  1916 132 

Hides  and  skins : 

Disinfection  by  bichloride  of  mercury  solution,  Treasury  Department  require- 
ments as  to 85-88,  126,  12T 

Disinfection  of,  joint  order  No.   1 126,  127 

Great  Britain,  text  of  regulations  governing  hides  and  skins  imported  from 

China  or  West  Coast  of  India,  1901 136 

Imports  of,  into  the  United  States,  1910  to  1915 84 

Legislation,  protective,  covering  the  industry,  Europe 110,  111 

Massachusetts,  rules  and  regulations  suggested  as  to  disinfection  of 132 

Histories,  individual,  of  fatal  cases  reported  in  registration  area,  United  States, 

1910  to  1915 60-78 

History  and  general  description  of  anthrax  (Chapter  I) 9-13 

Animals  subject  to  anthrax,  and  countries  where  disease  is  prevalent 12 

Bacillus  and   its   spore,    characteristics   of 11, 12 

Bacillus,    discovery    of 10 

Conditions  of  soil  and  temperature  favorable  to  development  of  anthrax 13 

Disease,  early  studies  of  the 9 

Infections,    modes    of 13 

Holland,  anthrax  cases  reported  in,  1898  to  1911 104 

Holland,  compulsory  reporting  laws  and  resultant  data 105 

Horse  and  other  animal  hair  manufactured,   imports  of,  into  the  United   States, 

1910  to  1915 84 

Horsehair  from  China,  Siberia,  or  Russia,  use  of,  text  of  regulations  governing, 

Great  Britain,  1908 141-143 

Horsehair-spinning  establishments,  equipment  and  operation  of,  text  of  order  con- 
cerning,   Germany,    1902 145-148 

Horsehair  workers,  personal  precautions  of,  text  of  regulations  governing.  Great 

Britain,  1908 142,  143 

Hungary,  wool,  hair,  and  bristle  industry  in,  protective  legislation 110 

Hygienic  measures,  special,  affecting  establishments  where  workers  are  exposed  to 

anthrax  infection,  text  of  decree  relating  to,  France,  1913 143-145 

I. 

Imports  of  animal  products  liable  to  be  infected  with  anthrax,  1910  to  1915 84 

Industries  affected   (Chapter  III) 19-23 

Infants,  fatal  cases  reported  of,  registration  area,  United  States,  1910  to  1915 53  ( 

Infection : 

Animal  hair  and  bristle  industry,  risk  of 20,  21 

Horn  and  bone  industry,  risk  of 22 

Leather  industry,  risk  of 19,  20 

Modes    of 13 

Nonoccupational 23 

Transportation  industry,   risk  of 22 

Wool  industry,  risk  of 21,22 

International  Association  for  Labor  Legislation,  subcommittee  of,  recommenda- 
tions of 121-123 

International  organizations  and  congresses,  activity  of,  Europe 98 

Italy,  anthrax  cases  reported  in,  1890  to  1904 105 

Italy,   compulsory   reporting  laws   and  resultant  data . 105,  106 

L. 

Legislation,  protective,  in  Europe , 106-111 

Legislation,  United  States 80-93 

Locality.     (See  Place,  etc.) 


154  INDEX. 

M. 

Page. 
Manufacture  and  trade,  prevention  of  anthrax  in,  legislation  in  regard  to,  United 

States 84-88 

Massachusetts : 

Board  of  Labor  and  Industries,  rules  and  regulations  suggested  by,  1916 131-134 

Hospital,  cases  on  record  in  a 41-43 

Workmen's  compensation  law,  claims  filed  under,  on  account  of  anthrax,  three 

years  ending  June  30,  1915 . 89 

Massarelli,  F.,  and  Prof.  L.  Devoto,  recommendations  by,  for  control  and  preven- 
tion   of    anthrax 123,124 

Meats,    packed    in    straw,    import   from    certain    countries    prohibited,    joint    order 

No.  1 129,  130 

Medical  aspects  of  human  anthrax,  symptoms,  treatment,  etc.   (Chapter  II) 15-1S 

Milan    (Italy)   Labor  Clinic,  activity  of 97,  98 

Morocco-leather  center,  in  Delaware,  experience  of 32-35 

N. 

Nativity,  age,  sex,  and  conjugal  condition  of  fatal  cases  reported  in  registration 

area,  United  States,  1910  to  1915 54-59 

New  Jersey  occupational  disease  reporting  law,  cases  reported  under 37,  38 

New  York  : 

Occupational  disease  reporting  law,  case's  reported  under 35—37 

State   Industrial   Commission,   recommendations 134,  135 

Nonoccupational    anthrax 23 

O. 

Occupations  reported  in  anthrax  cases  : 

Barbers  and  hairdressers '. : 52,  53 

Bristle    combing , 52 

Customs    weighing 51 

Farming  and  ranching 49,50 

Freight   handling 51 

Hair  working  and  weaving 51 

Hide  and   skin   workers 43 

Housekeepers 53 

Laborers : 53 

Liverymen 52 

Longshore    work 50,  51 

Musician 53 

Paper    making 52 

Tanning  and  leather  manufacturing,  various   occupations  in 44,45 

Tanning,    United    States 49 

Transportation  workers 43 

Truck    driving 51 

Veterinary  surgery 52 

Wool  and  hair  workers 43 

Woolsorting 51,  52 

P. 

Page,  C.  H.  W.,  recommendations  by,  for  control  and  prevention  of  anthrax 124, 125 

Page,  C.  H.  W.,  recorded  cases  of  human  anthrax  in  Italy,  1S90  to  1904 105 

Pennsylvania  infectious  disease  reporting  law,  cases  reported  under 38,  39 

Personal  precautions  of  workers  : 

Great  Britain,   horsehair,   processes   involving  use   of 142,  143 

Great  Britain,  wool,  goat  hair,  and  camel  hair 139 

Massachusetts,   suggested   rules   and   regulations 133,  134 

New    York,    recommendations 135 

Philadelphia  hospital,  cases  on  record  in  a : 39-41 

Place  and  date  of  fatal  cases,  registration  area,  United  States,  1910  to  1915 54-59 

Potassium,  permanganate  of,  disinfection  by  boiling  in  solution  of 115 

Prevention  and  control  of  anthrax : 

Devoto,  Prof.  L.,  and  F.  Massarelli,  recommendations  by 123,  124 

France,  text  of  regulations 143-145 

Germany,  text  of  regulations : _- 145-148 

Great  Britain,   text   of   regulations 136-143 


INDEX.  155 

Prevention  and  control  of  anthrax — Continued.  Page. 
International    Association    for    Labor    Legislation,    subcommittee    of,    recom- 
mendations  of 121-123 

Legislation  in  United  States 82-88 

Massachusetts,  rules  and  regulations  suggested 131-134 

Page,  C.  H.  W.,  recommendations  by 124,125 

Prussia,  text  of  regulations 148-150 

Prussia,   propagation   of  anthrax   through   animal    skins   in,    text   of   order    relat- 
ing   to,    1902 ' 148,  149 

Prussia,  protection  of  workers  against  anthrax  in,  text  of  regulations  for,  1910_   149,  150 

Prussia.     (See  also  Germany.) 

Q. 

Quarantine  and  vaccination  of  farm  animals 83 

Quarantine  placards  and  notice  to  employees,  Delaware 34 

R. 

Regulations  for  the  control  of  anthrax.    (See  Prevention  and  control  of  anthrax.) 

Reporting,  compulsory,  legislation  in  regard  to,  United  States 80-82 

Reporting,  systematic,  and  resultant  data,  Europe 99-10G 

Russia,  cases  of  anthrax 106 

Russia.      (See  also   China,   Siberia,   or  Russia,   horsehair   from,   etc.) 

S. 

Sanitation  of  workshops,  recommendations,  New  York 135 

Sanitation  of  workshops,  suggested  rules  and  regulations,  Massachusetts,  1916 133 

Sanitation  of  workshops,  text  of  order  concerning,  Germany,  1902 147,  148 

Sehattenfroh  method  of  disinfection,  for  hides  and  skins 118-120,  132 

Serums 18 

Sex  of  anthrax  cases  reported,  in  France,  and  in  Germany,  1910  to  1912 103,  104 

Sex.     (See  also  Nativity,  age,  sex,  and  conjugal  condition  of  fatal  cases,  etc.) 

Seymour-Jones  method  of  disinfection  for  hides  and  skins 118,  119,  132 

Siberia.      (See  China,  Siberia,  or  Russia,  horsehair  from,  etc.) 

Steam   sterilization,   effect   of,    on   wool 116 

Symptoms  of  human  anthrax : 15,  16,  134 

T. 

Tanners  and  leather  manufacturers   (19),  cases  reported  by 44,45 

Trade    and    manufacture,    prevention    of    anthrax    in,    legislation    in    regard    to, 

United   States 84-88 

Treasury,  Department  of,  and  Department  of  Agriculture,  joint  order  No.   1 126-130 

Treatment  of  human   anthrax 16-18 

U. 
United  States,  anthrax  in   (Chapter  IV) 25-93 

V. 
Vaccination  and  quarantine  of  farm  animals 83 

W. 

Wool  and  hair,  disinfection  of,  joint  order  No.   1 128,129 

Wool,  goat  hair,  and  camel  hair,  sorting,  washing,  combing,  etc.,  of,  text  of  regu- 
lations governing,  Great  Britain,  1905 : , 137-140 

Wool,  goat  hair,  camel  hair,  etc.,  imports  of,  into  the  United  States,  1910  to  1915-  84 

Wool,  hair,  and  bristles  industry,  protective  legislation  as  to,  Europe , 107-110 

Wool  industry,  anthrax,  cases  in,   reported  by  Bradford    (England)    and  District 

Anthrax  Investigation  Board,  1906  to  1914 101 

Workmen's  compensation  act,  British,  cases  of  anthrax  compensated  under,  1908 

to    1914 113 

Workmen's  compensation  law,  claims  filed  under  on  account  of  anthrax,   Massa- 
chusetts, three  years  ending  June  30,  1915 89 

Workshops,  sanitation  of,  recommendations,  New  York 135 

Workshops,  sanitation  of,  suggested  rules  and  regulations,  Massachusetts 133 

Workshops,  sanitation  of,  text  of  European  regulations  as  to  (Appendix  B) 136-150 


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